1497976112 NPI number — NOAH LAMOND KELLER D.O.

Table of content: NOAH LAMOND KELLER D.O. (NPI 1497976112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497976112 NPI number — NOAH LAMOND KELLER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLER
Provider First Name:
NOAH
Provider Middle Name:
LAMOND
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497976112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10119 EASTERDAY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21742-9791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-725-8132
Provider Business Mailing Address Fax Number:
716-725-8132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WASHINGTON COUNTY HOSPITAL
Provider Second Line Business Practice Location Address:
251 EAST ANTIETAM STREET
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-5771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-790-8372
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  H0065688 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 412801000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 451601000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00433451 . This is a "RAILROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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