Provider Demographics
NPI:1174587406
Name:CUSSON, BARRY CHRISTOPHER (PA)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:CHRISTOPHER
Last Name:CUSSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 LAFAYETTE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5679
Mailing Address - Country:US
Mailing Address - Phone:603-431-1121
Mailing Address - Fax:603-431-9147
Practice Address - Street 1:1900 LAFAYETTE RD
Practice Address - Street 2:SUITE A
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5679
Practice Address - Country:US
Practice Address - Phone:603-431-1121
Practice Address - Fax:603-431-9147
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0244P207X00000X
MEPA460207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99904925Medicaid
S16480Medicare UPIN
NHCUAP0301Medicare ID - Type Unspecified