Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 213688 | MA |
N | 2084N0402X | Child Neurologist | 8711 | NH |
NPI | 1164459368 |
---|---|
Provider Name | Dr. Brian David Kossak |
First Address | Manchester, NH 03102-3765 |
Second Address | Manchester, NH 03102-3765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F36946 | (02) | NH |