Individual
MR. CHANEL G BOUCHEREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 STAFFORD STREET, SUITE 113, SPRINGFIELD, MA 01104-3581
(413) 737-9746
(413) 739-1320
Mailing address
300 STAFFORD STREET, SUITE 113, SPRINGFIELD, MA 01104-3581
(413) 737-9746
(413) 739-1320
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
45636
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0166014
—
MA
01
—
10754
HNE
MA
01
—
N51761
BLUE CROSS
MA
Enumeration date
11/22/2006
Last updated
04/12/2010
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