Provider Demographics
NPI:1437145588
Name:KELLERMEYER, WILLIAM FREDERICK JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:KELLERMEYER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:FLINTSTONE
Mailing Address - State:MD
Mailing Address - Zip Code:21530-0144
Mailing Address - Country:US
Mailing Address - Phone:301-478-2043
Mailing Address - Fax:
Practice Address - Street 1:600 MEMORIAL AVE
Practice Address - Street 2:MEMEORIAL OFFICE BLDG.
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3765
Practice Address - Country:US
Practice Address - Phone:301-723-4965
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018048207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology