Individual
DR. RAYMOND WALTER KELLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9 CINDY LN, MARMORA, NJ 08223-1169
(609) 536-9864
Mailing address
9 CINDY LN, MARMORA, NJ 08223-1169
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OT018072
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT018072
PA STATE TRAINING LICENSE
PA
Enumeration date
06/23/2017
Last updated
09/15/2021
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