Individual
IRINA A. ANSELM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
300 LONGWOOD AVE, FEGAN 11, BOSTON, MA 02115-5724
(617) 355-2758
(617) 730-0285
Mailing address
300 LONGWOOD AVE, FEGAN 11, BOSTON, MA 02115-5724
(617) 355-2758
(617) 730-0285
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
152304
MA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
152304
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3183891
—
MA
Enumeration date
05/23/2006
Last updated
08/27/2007
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