MEDICARE: CHRISTOPHER J. MANCUSO DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	18743	NH

General Provider Information

NPI Number	:	1255725529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER J. MANCUSO DO

Provider Business Mailing Address
First Line	:	111 NEW HAMPSHIRE AVE STE 2
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-2864
Country	:	US
Telephone Number	:	330-947-6021
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 PROSPECT ST STE N-301
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03060
Country	:	US
Telephone Number	:	603-579-9648
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	04/14/2026

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