Provider Demographics
NPI:1518933589
Name:PATRISSO, DANIEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:PATRISSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:85 SPRING ST
Mailing Address - Street 2:STE 302
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3113
Mailing Address - Country:US
Mailing Address - Phone:603-524-8660
Mailing Address - Fax:603-528-6220
Practice Address - Street 1:85 SPRING ST
Practice Address - Street 2:STE 302
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3113
Practice Address - Country:US
Practice Address - Phone:603-524-8660
Practice Address - Fax:603-528-6220
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH7001208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81344154Medicaid
NH0105305Y0NH01OtherANTHEM BCBS
NHRE0256Medicare PIN
NH81344154Medicaid