Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dominique Ketsoglou, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1629838222

Dominique Ketsoglou, MD is a Student in an Organized Health Care Education/Training Program in Bay Shore, New York. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

301 E Main St
Bay Shore, NY 11706-8408
Phone: (631) 968-3000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1629838222
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 20, 2024
Last updated in NPPESMarch 20, 2024
Certification dateMarch 20, 2024

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