Individual
SUSAN DIANE BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2 CHURCH ST S, SUITE 511, NEW HAVEN, CT 06519-1717
(203) 764-9199
(203) 764-9149
Mailing address
300 GEORGE ST, 6TH FLOOR, NEW HAVEN, CT 06536-0805
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
028443
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001284439
—
CT
Enumeration date
11/25/2005
Last updated
08/04/2008
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