Provider Demographics
NPI:1467443168
Name:HUSARIK, NANCY S (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:HUSARIK
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 1:15 FREETOWN RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-2358
Mailing Address - Country:US
Mailing Address - Phone:603-895-8000
Mailing Address - Fax:603-895-8099
Practice Address - Street 1:15 FREETOWN RD
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-2358
Practice Address - Country:US
Practice Address - Phone:603-895-8000
Practice Address - Fax:603-895-8099
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11505207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3901080OtherUHC PIN
NH30201960Medicaid
NHH28192OtherANTHEM REFERRING UPIN
NHNH2379OtherHPHC PIN
NH2727667OtherAETNA PIN
NH579620OtherCIGNA PIN
NH011505OtherTUFTS PIN
NH2727667OtherAETNA PIN
NH30201960Medicaid