Provider Demographics
NPI:1619070919
Name:HANISSIAN, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:HANISSIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 SWIFTWATER ROAD
Mailing Address - Street 2:COTTAGE HOSPITAL
Mailing Address - City:WOODSVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03785-2001
Mailing Address - Country:US
Mailing Address - Phone:603-747-9000
Mailing Address - Fax:603-747-0401
Practice Address - Street 1:90 SWIFTWATER ROAD
Practice Address - Street 2:COTTAGE HOSPITAL
Practice Address - City:WOODSVILLE
Practice Address - State:NH
Practice Address - Zip Code:03785-2001
Practice Address - Country:US
Practice Address - Phone:603-747-9000
Practice Address - Fax:603-747-0401
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12602207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011922Medicaid
NH01Y008509NH03OtherPROVIDER ID
NHCOTT0008186OtherPROVIDER ID
NH30205497Medicaid
NH4146981OtherPROVIDER ID
VT1011922Medicaid
NHI38082Medicare UPIN