Cory J Keller
Family Doctor - Sports Medicine
3509 N Broad St
Philadelphia
, Pennsylvania 19140-4105
Cory J Keller
Family Doctor - Sports Medicine
3509 N Broad St
Philadelphia
, Pennsylvania 19140-4105
(215) 707-2324
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About
Features
Specialties
- Family Doctor - Sports Medicine
Languages spoken
- English
Location
First Address
- Cory J Keller
- 2450 W Hunting Park Ave
- Philadelphia, PA
- Zip : 19129-1302
- Fax : (215) 707-2324
- Phone : (215) 707-2111
Second Address
- Cory J Keller
- 3509 N Broad St
- Philadelphia, PA
- Zip : 19140-4105
- Fax : (215) 707-2324
- Phone : (215) 707-2111
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QS0010X | Family Doctor - Sports Medicine | OS013775 | PA |
National Provider Identifier
| NPI | 1265649206 |
|---|---|
| Provider Name | Cory J Keller |
| First Address | Philadelphia, PA 19129-1302 |
| Second Address | Philadelphia, PA 19140-4105 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/05/2007 |
| Last Update Date | 04/02/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 102312897 | (05) | PA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.