Provider Demographics
NPI:1992775035
Name:KUSICK, DANIEL S (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:KUSICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:77 SUNRISE ST
Mailing Address - Street 2:
Mailing Address - City:LANESBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01237-9711
Mailing Address - Country:US
Mailing Address - Phone:413-441-3406
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5004
Practice Address - Country:US
Practice Address - Phone:413-441-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0017416207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA682800OtherTUFTS HEALTHPLAN
MA3064158Medicaid
MAJ09960OtherBCBSMA
NY01673005Medicaid
NY391496OtherMVP
MA13717OtherHEALTH NEW ENGLAND
NY10034426OtherCDPHP
MAE61760OtherHARVARD PILGRIM HEALTHCAR
MAJ09960OtherBCBSMA
E61760Medicare UPIN