Individual
MATTHEW P BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 HOWARD AVE, DEPARTMENT OF EMERGENCY MEDICINE, ALTOONA, PA 16601-4899
(814) 889-2866
(814) 889-6785
Mailing address
620 HOWARD AVE, ALTOONA REGIONAL HEALTH SYSTEM, ALTOONA, PA 16601-4899
(814) 889-2866
(814) 889-6785
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD069555L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102194588
—
PA
01
—
926133
BLUE SHIELD
PA
Enumeration date
05/26/2006
Last updated
03/20/2012
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