Provider Demographics
NPI:1871774034
Name:ABINGTON FAMILY HEALTHCARE, LLC
Entity type:Organization
Organization Name:ABINGTON FAMILY HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-974-0529
Mailing Address - Street 1:5 CLINIC RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06230-2005
Mailing Address - Country:US
Mailing Address - Phone:860-974-0529
Mailing Address - Fax:860-974-1029
Practice Address - Street 1:5 CLINIC RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:CT
Practice Address - Zip Code:06230-2005
Practice Address - Country:US
Practice Address - Phone:860-974-0529
Practice Address - Fax:860-974-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02858Medicare PIN
CTB37834Medicare UPIN