Basic Information
Provider Information | |||||||||
NPI: | 1215958418 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KOSSAYDA | ||||||||
FirstName: | NORMAN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 380 LAFAYETTE RD | ||||||||
Address2: |   | ||||||||
City: | HAMPTON | ||||||||
State: | NH | ||||||||
PostalCode: | 038422222 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6039260088 | ||||||||
FaxNumber: | 6039262853 | ||||||||
Practice Location | |||||||||
Address1: | 172 KINSLEY ST | ||||||||
Address2: |   | ||||||||
City: | NASHUA | ||||||||
State: | NH | ||||||||
PostalCode: | 030603648 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035953061 | ||||||||
FaxNumber: | 6038893774 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/22/2006 | ||||||||
LastUpdateDate: | 09/03/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 7087 | NH | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 0107537Y0NH03 | 01 | NH | ANTHEM | OTHER | 0107537Y0NH05 | 01 | NH | ANTHEM | OTHER | 729494 | 01 |   | TUFTS | OTHER | 415920 | 01 |   | CIGNA | OTHER | 930070458 | 01 | NH | RAILROAD MEDICARE | OTHER | AA79918 | 01 |   | HARVARD PILGRIM | OTHER | P00732350 | 01 | NH | RAILROAD MEDICARE | OTHER | 30007979 | 05 | NH |   | MEDICAID | 3073246 | 05 | MA |   | MEDICAID |