Basic Information
| Provider Information | |||||||||
| NPI: | 1427068873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VETTERS | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | GILLILAND | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021431935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176234201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 KNEELAND ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174578140 | ||||||||
| FaxNumber: | 6174578141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 227788 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 227788 | 01 | MA | STATE MEDICAL LICENSE | OTHER |