Provider Demographics
NPI:1225064629
Name:GOSSELIN, BENOIT J (MD, FRCSC)
Entity Type:Individual
Prefix:DR
First Name:BENOIT
Middle Name:J
Last Name:GOSSELIN
Suffix:
Gender:M
Credentials:MD, FRCSC
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Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DARTMOUTH-HITCHCOCK MEDICAL CENTER-OTOLARYNGOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-8123
Mailing Address - Fax:603-650-0052
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DARTMOUTH-HITCHCOCK MEDICAL CENTER-OTOLARYNGOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-8123
Practice Address - Fax:603-650-0052
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH9448207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1194Medicaid
NH80003811Medicaid
VTVN1194Medicare PIN
NHRE381101Medicare PIN
NH80003811Medicaid