Keller Dermatopathology Med GRP Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF11769 Issued in CA

Legal business name

KELLER DERMATOPATHOLOGY MED GRP INC

Practice address

401 29TH St
Suite 109
Oakland, CA 94609-3519

Phone

(510) 663-6204

NPI assigned

Aug 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Albert R Keller, MDNPI 1548273014

Title

President

Phone

(510) 663-6204

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Albert R Keller, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Oakland, CA
  • NPI 1548273014
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356354823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 282848",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941282848",
            "telephone_number": "650-616-2948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 29TH ST",
            "address_2": "SUITE 109",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093519",
            "telephone_number": "510-663-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLER DERMATOPATHOLOGY MED GRP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-663-6204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF11769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ06208Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB08537F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin McKenzie Keizur, MD
• Alec Emery Kelemen, OD
• Anna Yaya Kelleher, MSW
• Julianne Mariss Kelleher
• Madison Rosario Kelleher
• Albert R Keller, MD
• Linda Eileen Keller, PH.D.
• Murphy Keller, PTA
• Rachel Keller, MSW
• Devyn J Kelley

• Clinical Medical Laboratory in Oakland, CA
• Providers in Oakland, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.