Individual
ROBERT JERROLD RACUSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL CENTER DR, DHMC, DEPARTMENT OF PSYCHIATRY, LEBANON, NH 03756-1000
(603) 650-5835
(603) 650-0819
Mailing address
1 MEDICAL CENTER DR, DHMC, DEPARTMENT OF PSYCHIATRY, LEBANON, NH 03756-1000
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
5075
NH
2084P0804X
Child & Adolescent Psychiatry Physician
5465
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000792
—
NH
01
—
0004602
MEDICAID
VT
Enumeration date
12/01/2006
Last updated
07/16/2007
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