Healthcare Provider Details

I. General information

NPI: 1619070919
Provider Name (Legal Business Name): JEFFREY HANISSIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 SWIFTWATER ROAD COTTAGE HOSPITAL
WOODSVILLE NH
03785-2001
US

IV. Provider business mailing address

90 SWIFTWATER ROAD COTTAGE HOSPITAL
WOODSVILLE NH
03785-2001
US

V. Phone/Fax

Practice location:
  • Phone: 603-747-9000
  • Fax: 603-747-0401
Mailing address:
  • Phone: 603-747-9000
  • Fax: 603-747-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number12602
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12602
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: