=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417905720
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INNA KETSLER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 06/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 MEMORIAL DR SUITE 202
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-466-5155
-----------------------------------------------------
Fax | 978-466-3853
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 WARWICK DR
-----------------------------------------------------
City | CHELMSFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01824-3768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-250-1219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RS0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 74268
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 74268
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------