Provider Demographics
NPI:1497927313
Name:CONNELL-BOUDOYA, ELISE J (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:J
Last Name:CONNELL-BOUDOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4440
Mailing Address - Country:US
Mailing Address - Phone:860-585-8935
Mailing Address - Fax:
Practice Address - Street 1:102 MOODY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4440
Practice Address - Country:US
Practice Address - Phone:860-585-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0445072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology