Individual
KARI BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 EVERGREEN DR, SUITE 20, GLEN MILLS, PA 19342-1032
(484) 785-3376
(610) 358-6913
Mailing address
500 EVERGREEN DR, SUITE 20, GLEN MILLS, PA 19342-1032
(484) 785-3376
(610) 358-6913
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD417529
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1438394
BLUE SHIELD
PA
01
—
2122596000
IBC
PA
Enumeration date
10/31/2006
Last updated
09/09/2014
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