Healthcare Provider Details

I. General information

NPI: 1356604557
Provider Name (Legal Business Name): KHRISAN GOSAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CYPRESS ST STE 8
MANCHESTER NH
03103
US

IV. Provider business mailing address

445 CYPRESS ST STE 8
MANCHESTER NH
03103-3600
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-4079
  • Fax: 603-663-8605
Mailing address:
  • Phone: 603-668-4079
  • Fax: 603-663-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number18733
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18733
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: