Individual
KEITH MCNELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-1622
(215) 707-0943
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-1622
(215) 707-0943
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD422449
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008228410061
—
PA
Enumeration date
10/13/2005
Last updated
04/10/2018
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