Donald Francis Bouchard
Individual provider Active NPI Contractor · Chester, CT
NPI 1003004532 · NPPES record last updated Oct 10, 2007
Key facts
- NPI
- 1003004532
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 17 Waterhouse LN
Chester, CT 06412-1267 - Phone
- (860) 526-4333
- Fax
- (860) 526-4333
- NPI assigned
- Oct 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | CT | Yes |
Addresses
Primary practice location
17 Waterhouse LN
Chester, CT 06412-1267
Mailing address
17 Waterhouse LN
Goldstar Medical Services, Inc.
Chester, CT 06412
Phone (860) 526-4333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GO376254 | Other | CT | BLUE CROSS/SHIELD MA |
| 12DME0363CT02 | Other | CT | ANTHEM BLUE CROSS CT |
Other providers in Chester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.