Provider Demographics
NPI:1962640722
Name:BOUCHARD, AMY RUTH (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:RUTH
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:99 EAST RIVER DR
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7301
Mailing Address - Country:US
Mailing Address - Phone:860-282-4133
Mailing Address - Fax:860-289-0742
Practice Address - Street 1:80 SEYMOUR STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5539
Practice Address - Country:US
Practice Address - Phone:860-545-2117
Practice Address - Fax:860-545-1784
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-31
Last Update Date:2013-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT046574207LP3000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology