Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 21754 | NH |
N | 208600000X | Surgeon | 21754 | NH |
N | 208200000X | Surgeon | 238672 | MA |
N | 208600000X | Surgeon | 238672 | MA |
Y | 2086S0102X | Surgical Critical Care | 21754 | NH |
N | 2086S0102X | Surgical Critical Care | 238672 | MA |
N | 2086S0127X | Trauma Surgeon | 238672 | MA |
NPI | 1356575062 |
---|---|
Provider Name | Dr. Michael George Debusk |
First Address | Concord, NH 03301-2548 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2009 |
Last Update Date | 01/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110092666A | (05) | MA |
3106715 | (05) | NH |