Healthcare Provider Details

I. General information

NPI: 1255725529
Provider Name (Legal Business Name): CHRISTOPHER J. MANCUSO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 PROSPECT ST STE N-301
NASHUA NH
03060
US

IV. Provider business mailing address

PO BOX 3677
NASHUA NH
03061-3677
US

V. Phone/Fax

Practice location:
  • Phone: 603-579-9648
  • Fax:
Mailing address:
  • Phone: 603-577-7900
  • Fax: 603-577-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number18743
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: