Provider Demographics
NPI:1639268311
Name:KESZLER, KORNELIA (MD)
Entity Type:Individual
Prefix:
First Name:KORNELIA
Middle Name:
Last Name:KESZLER
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 1:1-B MEIGSWOOD
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
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT16467207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001664672Medicaid
CT060000078Medicare ID - Type Unspecified
CT001664672Medicaid
D02793Medicare UPIN