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Individual

DEREK H. KELLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
593 EDDY STREET, DAVOL 129, PROVIDENCE, RI 02903-4923
(401) 444-4933
(401) 444-5090
Mailing address
ONE VIRGINIA AVENUE, SUITE 201, PROVIDENCE, RI 02905
(401) 490-0916
(401) 490-0979

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
13888
RI
207L00000X
Anesthesiology Physician
Primary
MD13888
RI
207R00000X
Internal Medicine Physician
236696
MA

Other

Enumeration date
09/18/2008
Last updated
10/04/2013
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