Individual
DR. DANIEL L BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
725 ALBANY ST, STE 9B & C, SHAPIRO BLDG, BOSTON, MA 02118-2526
(617) 414-4290
(617) 414-4285
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
243941
MA
207RI0200X
Infectious Disease Physician
Primary
243941
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1100907782A
—
MA
Enumeration date
06/22/2007
Last updated
06/21/2023
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