Organization
ROY A. KELLERMAN, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROY A KELLERMAN M.D. (DOCTOR)
(860) 243-5569
Entity
Organization
Contact information
Practice address
701 COTTAGE GROVE RD STE A110, BLOOMFIELD, CT 06002-3082
(860) 243-5569
(860) 243-2622
Mailing address
701 COTTAGE GROVE RD STE A110, BLOOMFIELD, CT 06002-3082
(860) 243-5569
(860) 243-2622
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23862
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001238625
—
CT
01
—
010023862CT05
BC/BS
CT
01
—
110008097
MEDICARE
CT
Enumeration date
04/29/2008
Last updated
08/02/2010
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