Individual
ANITA L BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
(860) 224-5556
Mailing address
1 LIBERTY SQ, PO BOX 217, NEW BRITAIN, CT 06051-2637
(860) 827-0071
(860) 229-5642
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
029902
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001299024
—
CT
Enumeration date
12/28/2005
Last updated
06/22/2015
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