1710963046 NPI number — FRANCIS L KELTZ

Table of content: FRANCIS L KELTZ (NPI 1710963046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710963046 NPI number — FRANCIS L KELTZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELTZ
Provider First Name:
FRANCIS
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KELTZ
Provider Other First Name:
F
Provider Other Middle Name:
LEO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710963046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1820 HAMPDEN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19604-1606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-372-6874
Provider Business Mailing Address Fax Number:
610-372-9689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 HAMPDEN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19604-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-372-6874
Provider Business Practice Location Address Fax Number:
610-372-9689
Provider Enumeration Date:
12/19/2005

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: 111N00000X , with the licence number:  DC001398L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 114233 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02555500 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3000113 . This is a "KEYSTONE HEALTH PLAN CENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5314179 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".