Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 030360 | CT |
NPI | 1013943810 |
---|---|
Provider Name | Andrew Keller |
First Address | Danbury, CT 06810-5954 |
Second Address | Danbury, CT 06810-5954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A63065 | (02) | CT |