Individual
CORY J KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3509 N BROAD ST, PHILADELPHIA, PA 19140-4105
(215) 707-2111
(215) 707-2324
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-2111
(215) 707-2324
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
OS013775
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102312897
—
PA
Enumeration date
05/17/2007
Last updated
02/04/2021
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