Keller, Cory J

Keller, Cory J is an individual health care provider with primary practice located at 3509 N Broad St , Philadelphia PA 19140-4105. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Keller, Cory J can be contacted via phone (215) 707-2111.

Contact Information

Primary practice address
3509 N Broad St Philadelphia PA 19140-4105
Phone: (215) 707-2111
Fax: (215) 707-2324
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X OS013775 Pennsylvania

Profile Details

NPI number 1265649206
LBN Legal business name Keller, Cory J
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2007
Last updated Feb 4th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265649206 NPPES
Pennsylvania MEDICAID 102312897

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