Individual
DR. KEVIN E BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5 CLINIC RD, ABINGTON, CT 06230-2005
(860) 974-0529
(860) 974-1029
Mailing address
5 CLINIC RD, ABINGTON, CT 06230-2005
(860) 974-0529
(860) 974-1029
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
000211
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001002112
—
CT
01
—
040000211CT-04
ANTHEM BCBS
CT
01
—
051180
HEALTHNET
CT
01
—
1770258-003
CIGNA
CT
01
—
4476899
AETNA
CT
01
—
WIP019
OXFORD
CT
Enumeration date
12/20/2006
Last updated
04/19/2010
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