Provider Demographics
NPI:1891764718
Name:BOUCARD, HERVE C (MD)
Entity Type:Individual
Prefix:
First Name:HERVE
Middle Name:C
Last Name:BOUCARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 WHITEHORSE HAMILTON SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3701
Mailing Address - Country:US
Mailing Address - Phone:609-586-1319
Mailing Address - Fax:609-586-1468
Practice Address - Street 1:1374 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3701
Practice Address - Country:US
Practice Address - Phone:609-586-1319
Practice Address - Fax:609-586-1468
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07717700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ103217Medicaid
NJ2622135OtherUHC
NJ7436839OtherAETNA PPO
NJP3714409OtherOXFORD
NJ0104386OtherGHI
NJ60032894OtherHORIZON NJ HEALTH
NJ7716069OtherCIGNA
NJ222233588OtherHORIZON BC/BS
NJ3K3753OtherHEALTHNET
NJ01007810900OtherAMERICHOICE
NJ1216331OtherAETNA HMO
NJ7436839OtherAETNA PPO
NJI66444Medicare UPIN