MARTHA A BOUCHARD MD (Credential# 152176) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2009. The license expiration date date is February 28, 2011. The license status is INACTIVE.
MARTHA A BOUCHARD MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0012410. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2009. The expiration date is February 28, 2011. The business address is 42 Coulter Avenue, Pawling, NY 12564. The current status is inactive.
| Licensee Name | MARTHA A BOUCHARD MD |
| Credential ID | 152176 |
| Credential Number | CSP.0012410 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
42 Coulter Avenue Pawling NY 12564 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE |
| Issue Date | 2004-06-23 |
| Effective Date | 2009-03-01 |
| Expiration Date | 2011-02-28 |
| Refresh Date | 2013-03-07 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 545034 | 1.024502 | Physician/Surgeon | 1983-09-14 | 2008-07-21 - 2009-07-31 | INACTIVE |
| Street Address | 42 COULTER AVENUE |
| City | PAWLING |
| State | NY |
| Zip Code | 12564 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Joseph P Lazarcheck | 30 Taber Knolls Drive, Pawling, NY 12564 | Architect | 2020-08-01 ~ 2021-07-31 |
| Joseph Meunier & Sons Inc | 114 Quaker Hill Rd, Pawling, NY 12564 | Home Improvement Contractor | 2020-06-03 ~ 2020-11-30 |
| Anthony J Pandolfo | 20 Sunset Avenue, Pawling, NY 12564 | Physician Assistant | 2020-09-01 ~ 2021-08-31 |
| Claudia A Jiskra | 15 Dodge Rd, Pawling, NY 12564 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Elizabeth Cozzocrea | 14 Hunter Lane, Pawling, NY 12564 | Licensed Clinical Social Worker | 2020-04-01 ~ 2021-03-31 |
| Megan Bijou | 7 Leroy Lane, Pawling, NY 12564 | Physical Therapist | 2020-05-01 ~ 2021-04-30 |
| Gillian Stewart Real Estate LLC | 54 East Main St, Pawling, NY 12564 | Real Estate Broker | 2020-04-01 ~ 2021-03-31 |
| John R Burweger | 36 Valley View Lane, Pawling, NY 12564 | Real Estate Broker | 2020-04-01 ~ 2021-03-31 |
| Cynthia M Roth | 8 Grandview Avenue, Pawling, NY 12564 | Registered Nurse | 2020-03-01 ~ 2021-02-28 |
| Susan G Kernan | 21 Pine Drive, Pawling, NY 12564 | Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| Find all Licenses in zip 12564 | |||
| City | PAWLING |
| Zip Code | 12564 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + PAWLING |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Donna Bouchard | 9 Barry Ln, Simsbury, CT 06070-2001 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jillian Bouchard | 5 Sagamore Lane, Rocky Hill, CT 06067 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Alana Michelle Bouchard | 267 Cottage Grove Rd, Bloomfield, CT 06002-3145 | Controlled Substance Registration for Practitioner | 2020-06-19 ~ 2021-02-28 |
| Glen Bouchard Do · Rockville General Hospital | 15 Brookford Dr, Somers, CT 06071 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Martha G Welch Md | 235 Cognewaugh Rd, Cos Cob, CT 06807 | Controlled Substance Registration for Practitioner | 2019-04-09 ~ 2021-02-28 |
| Martha Zegarra | 78 Olive St Apt 326, New Haven, CT 06511-6986 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Martha Stewart | 115 Birdseye Rd, Farmington, CT 06032 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Martha E Haykin | 51 Clifford St, Hamden, CT 06517 | Controlled Substance Registration for Practitioner | 2006-03-01 ~ 2007-02-28 |
| Martha A Leroy Pa | 28 Reynolds Court, Del Mar, NY 12054 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
| Martha Spieker | 92 Beckett Ave, Branford, CT 06405 | Controlled Substance Registration for Practitioner | 1993-07-23 ~ 1995-02-01 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).