Provider Demographics
NPI:1427030758
Name:DUSETT, LEAH A (MD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:A
Last Name:DUSETT
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 1:14 KNOWLTON DR
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 KNOWLTON DR
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-2918
Practice Address - Country:US
Practice Address - Phone:978-264-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220968207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110039190AMedicaid
MA110039190AMedicaid
MAHX3648Medicare PIN
MAP00202446Medicare ID - Type UnspecifiedMEDICARE RAILROAD
MAA37444HRMedicare ID - Type UnspecifiedMEDICARE
MA2081750Medicaid
MA5586023OtherAETNA
MA469706OtherTUFTS HEALTH PLAN
MA2000005OtherUNITED HEALTHCARE
MAJ28009HROtherBLUE CROSS/SHIELD MA