Provider Demographics
NPI:1962446914
Name:BOUSKA, DAVID EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:BOUSKA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1941 NEW GARDEN RD STE 216
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2555
Practice Address - Country:US
Practice Address - Phone:336-288-8857
Practice Address - Fax:336-288-8769
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC34563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4503048OtherAETNA
NC0101250OtherUNITED HEALTHCARE
NC010055306OtherRAILROAD MEDICARE
NC17062OtherBLUE CROSS BLUE SHIELD
NC7279468OtherCIGNA
NC7917062Medicaid
NC46129OtherMEDCOST, LLC
NC7917062Medicaid
NC7279468OtherCIGNA