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Individual
MARK P. BOUCHARD
Active
Individual
MARK P. BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD14613
ME
207QS0010X
Sports Medicine (Family Medicine) Physician
MD14613
ME
208M00000X
Hospitalist Physician
MD14613
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
254100099
—
ME
Enumeration date
07/06/2006
Last updated
04/09/2020
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