Provider Demographics
NPI:1083893606
Name:KORNELIA KESZLER, MD, PC
Entity Type:Organization
Organization Name:KORNELIA KESZLER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESZLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-245-4343
Mailing Address - Street 1:1-B MEIGSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443
Mailing Address - Country:US
Mailing Address - Phone:203-245-4343
Mailing Address - Fax:203-245-5920
Practice Address - Street 1:1-B MEIGSWOOD AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443
Practice Address - Country:US
Practice Address - Phone:203-245-4343
Practice Address - Fax:203-245-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT16467207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01448Medicare PIN
D02793Medicare UPIN