Provider Demographics
NPI:1316225923
Name:BOURQUE, SUZANNE (MD, B SC)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:BOURQUE
Suffix:
Gender:F
Credentials:MD, B SC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:PLESSIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:498 ESSEX ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3990
Mailing Address - Country:US
Mailing Address - Phone:207-947-0558
Mailing Address - Fax:
Practice Address - Street 1:498 ESSEX ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3990
Practice Address - Country:US
Practice Address - Phone:207-947-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-31
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD194002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1316225923Medicaid