Organization
CHARLES A BOUCHER MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES ALLEN BOUCHER M.D. (PRESIDENT)
(617) 726-8511
Entity
Organization
Contact information
Practice address
8 HAWTHORNE PL, SUITE 110, BOSTON, MA 02114-2335
(617) 726-8511
(617) 742-8446
Mailing address
PO BOX 51512, BOSTON, MA 02205-1512
(617) 726-8511
(617) 742-8446
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
36588
MA
207RC0000X
Cardiovascular Disease Physician
Primary
36588
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
705823
TUFTS HEALTH PLAN
MA
05
—
9738193
—
MA
01
—
M13371
BLUE CROSS BLUE SHIELD OF
MA
Enumeration date
07/10/2007
Last updated
07/10/2007
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