Healthcare Provider Details

I. General information

NPI: 1417905720
Provider Name (Legal Business Name): INNA KETSLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MEMORIAL DR SUITE 202
LEOMINSTER MA
01453-2238
US

IV. Provider business mailing address

6 WARWICK DR
CHELMSFORD MA
01824-3768
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-5155
  • Fax: 978-466-3853
Mailing address:
  • Phone: 978-250-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number74268
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number74268
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: