Provider Demographics
NPI:1912939240
Name:BOULE, JUDITH ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANNE
Last Name:BOULE
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 1:69 ISLAND ST STE C
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3507
Mailing Address - Country:US
Mailing Address - Phone:603-354-6700
Mailing Address - Fax:603-354-6704
Practice Address - Street 1:69 ISLAND ST STE C
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3507
Practice Address - Country:US
Practice Address - Phone:603-354-6700
Practice Address - Fax:603-354-6704
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30004059Medicaid
NHBX6297Medicare PIN
E82519Medicare UPIN