Provider Demographics
NPI:1811948490
Name:BOUTIN, PIER (MD)
Entity type:Individual
Prefix:
First Name:PIER
Middle Name:
Last Name:BOUTIN
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 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4109
Mailing Address - Country:US
Mailing Address - Phone:413-447-2752
Mailing Address - Fax:413-496-6836
Practice Address - Street 1:27 LEWIS AVE
Practice Address - Street 2:ORTHOPEDICS AND SPORTS MEDICINE OF FAIRVIEW HOSPITAL
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2717
Practice Address - Country:US
Practice Address - Phone:413-854-9753
Practice Address - Fax:413-854-9732
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216742207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2029642OtherMASS HEALTH NUMBER
MAA36177Medicare UPIN