Boulware, Susan Diane
Boulware, Susan Diane is an individual health care provider with primary practice located at 2 Church St S Suite 511, New Haven CT 06519-1717. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Endocrinology, which is considered as her primary health care specialty. Boulware, Susan Diane can be contacted via phone (203) 764-9199.Contact Information
Primary practice address
2 Church St S Suite 511
New Haven CT 06519-1717
Phone: (203) 764-9199
Fax: (203) 764-9149
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Endocrinology | 2080P0205X | 028443 | Connecticut |
Profile Details
| NPI number | 1124001946 |
|---|---|
| LBN Legal business name | Boulware, Susan Diane |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 25th, 2005 |
| Last updated | Aug 4th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124001946 | NPPES |
| Connecticut | MEDICAID | 001284439 |
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