Susan Diane Boulware
Pediatric Endocrinologist
2 Church St S Suite 511
New Haven
, Connecticut 06519-1717
Susan Diane Boulware
Pediatric Endocrinologist
2 Church St S Suite 511
New Haven
, Connecticut 06519-1717
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About
Features
Specialties
- Pediatric Endocrinologist
Languages spoken
- English
Location
First Address
- Susan Diane Boulware
- 300 George St 6th Floor
- New Haven, CT
- Zip : 06536-0805
- Phone :
Second Address
- Susan Diane Boulware
- 2 Church St S Suite 511
- New Haven, CT
- Zip : 06519-1717
- Fax : (203) 764-9149
- Phone : (203) 764-9199
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2080P0205X | Pediatric Endocrinologist | 028443 | CT |
National Provider Identifier
| NPI | 1124001946 |
|---|---|
| Provider Name | Susan Diane Boulware |
| First Address | New Haven, CT 06536-0805 |
| Second Address | New Haven, CT 06519-1717 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 25/11/2005 |
| Last Update Date | 04/08/2008 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 001284439 | (05) | CT |
| E96476 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.