Keller, Cory J
Keller, Cory J is an individual health care provider with primary practice located at 3509 N Broad St , Philadelphia PA 19140-4105. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Keller, Cory J can be contacted via phone (215) 707-2111.Contact Information
Primary practice address
3509 N Broad St
Philadelphia PA 19140-4105
Phone: (215) 707-2111
Fax: (215) 707-2324
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Sports Medicine | 207QS0010X | OS013775 | Pennsylvania |
Profile Details
| NPI number | 1265649206 |
|---|---|
| LBN Legal business name | Keller, Cory J |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 17th, 2007 |
| Last updated | Feb 4th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265649206 | NPPES |
| Pennsylvania | MEDICAID | 102312897 |
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