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5 Clinic Rd Abington CT 06230-2005 | |
(860) 974-0529 | |
(860) 974-1029 |
Full Name | |
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Speciality | Family Medicine |
Location | 5 Clinic Rd, Abington, Connecticut |
Authorized Official Name and Position | Kevin E Boucher (OWNER) |
Authorized Official Contact | 8609740529 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5 Clinic Rd Abington CT 06230-2005 Ph: (860) 974-0529 | 5 Clinic Rd Abington CT 06230-2005 Ph: (860) 974-0529 |
NPI Number | 1871774034 |
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Provider Enumeration Date | 11/16/2007 |
Last Update Date | 04/20/2010 |
Medicare PECOS PAC ID | 7719017177 |
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Medicare Enrollment ID | O20100610000717 |
Identifier | Type | State | Issuer |
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1871774034 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 000211 (Connecticut) | Primary |
Provider Name | Kevin Eugene Boucher |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1992869523 PECOS PAC ID: 8628108081 Enrollment ID: I20100610000762 |