Individual
DR. CHARLES ALLEN BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8 HAWTHORNE PL, SUITE 110, BOSTON, MA 02114-2335
(617) 726-8511
(617) 726-9839
Mailing address
8 HAWTHORNE PL, SUITE 110, BOSTON, MA 02114-2335
(617) 726-8511
(617) 726-9839
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
36588
MA
207RC0000X
Cardiovascular Disease Physician
Primary
36588
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2064227
—
MA
01
—
705823
TUFTS HEALTH PLAN
MA
01
—
M09801
BCBS MA
MA
Enumeration date
03/15/2006
Last updated
05/05/2008
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