Provider Demographics
NPI:1417905720
Name:KETSLER, INNA (MD)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:KETSLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3768
Mailing Address - Country:US
Mailing Address - Phone:978-250-1219
Mailing Address - Fax:
Practice Address - Street 1:50 MEMORIAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2238
Practice Address - Country:US
Practice Address - Phone:978-466-5155
Practice Address - Fax:978-466-3853
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74268207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2296OtherHEALTHSOURCE
MA469686OtherAETNA
MA23240OtherHARVARD PILGRIM
MA3098176Medicaid
MAJ12941OtherBLUE CROSS BLUE SHIELD
MA14738OtherFALLON COMMUNITY HEALTH
MA4800282OtherUNITED HEALTHCARE
MA97766601OtherNETWORK HEALTH
MA074268OtherTUFTS HEALTH PLAN
MA97766601OtherNETWORK HEALTH
MA074268OtherTUFTS HEALTH PLAN
NH2296OtherHEALTHSOURCE