Provider Demographics
NPI:1174598510
Name:BOUCHER, MARTIN J (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:BOUCHER
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 1:46 BLUEBERRY HL
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4526
Mailing Address - Country:US
Mailing Address - Phone:603-569-6323
Mailing Address - Fax:
Practice Address - Street 1:46 BLUEBERRY HL
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4526
Practice Address - Country:US
Practice Address - Phone:603-569-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8070207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH383833OtherMVP
NHE68456OtherHARVARD PILGRIM HLTHCARE
NH0107072Y0NH01OtherANTHEM
NH3422723OtherAETNA
NH30002969Medicaid
NH9692314OtherCIGNA
NHE68456OtherHARVARD PILGRIM HLTHCARE
NH3422723OtherAETNA