Individual
DR. MARK ROBERT KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
197 NC HIGHWAY 42 N STE B, ASHEBORO, NC 27203
(336) 625-2560
Mailing address
550 WHITE OAK ST, ASHEBORO, NC 27203-4710
(336) 625-1360
(336) 625-1889
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
30821
NC
207Q00000X
Family Medicine Physician
Primary
30821
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48123
BLUE CROSS
NC
05
—
8948123
—
NC
Enumeration date
05/20/2006
Last updated
10/25/2020
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