Provider Demographics
NPI:1952394538
Name:CLAUSSEN, BRIAN E (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:CLAUSSEN
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 1:57 WEBSTER ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2552
Mailing Address - Country:US
Mailing Address - Phone:603-622-6491
Mailing Address - Fax:603-625-2080
Practice Address - Street 1:57 WEBSTER ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2552
Practice Address - Country:US
Practice Address - Phone:603-622-6491
Practice Address - Fax:603-625-2080
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2020-10-19
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
NH10608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200278Medicaid
NHCLRE5326Medicare ID - Type Unspecified
NHG96067Medicare UPIN