Provider Demographics
NPI:1730552423
Name:BUSCHMANN, COLE
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:BUSCHMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HUNTRESS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-4772
Mailing Address - Country:US
Mailing Address - Phone:917-696-2538
Mailing Address - Fax:
Practice Address - Street 1:98 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:HENNIKER
Practice Address - State:NH
Practice Address - Zip Code:03242-3292
Practice Address - Country:US
Practice Address - Phone:917-696-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002153-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker