Individual
LAWRENCE F BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
676 S BROADWAY ST, AKRON, OH 44311-1059
(330) 344-4000
(330) 253-2349
Mailing address
676 S BROADWAY ST, AKRON, OH 44311-1059
(330) 344-4000
(330) 253-2349
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-04-6863
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0170032
—
OH
01
—
1548207111
NPI GROUP NUMBER
OH
01
—
1841239274
MEDICARE/MEDICAID GROUP NPI #
OH
01
—
2551671
MEDICAID GROUP #
OH
01
—
9338635
MEDICARE GROUP NUMBER
OH
Enumeration date
01/19/2006
Last updated
09/22/2010
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