Provider Demographics
NPI:1689642688
Name:KUSSMAN, BARRY D (MB, BCH)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:D
Last Name:KUSSMAN
Suffix:
Gender:M
Credentials:MB, BCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDREN'S HOSPITAL BOSTON
Mailing Address - Street 2:300 LONGWOOD AVENUE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-6225
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL BOSTON
Practice Address - Street 2:300 LONGWOOD AVENUE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158310207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G91499Medicare UPIN