Individual
DAVID BRUCE BOUSLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320
(860) 442-0711
(203) 688-9638
Mailing address
20 YORK STREET, CB-2041, NEW HAVEN, CT 06510-3220
(203) 688-1734
(203) 688-9638
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
62616
CT
207P00000X
Emergency Medicine Physician
A96799
AS
207P00000X
Emergency Medicine Physician
MD11583
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06222010
TUFTS HEALTH PLAN
MA
01
—
06292010
BCBSRI
RI
01
—
07082010
NHPRI
RI
01
—
12142010
TRICARE
RI
01
—
1407870330
NPI
RI
05
—
7056948
—
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
Enumeration date
07/26/2006
Last updated
07/28/2020
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