SUSAN D BOULWARE MD (Credential# 547168) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is September 1, 2020. The license expiration date date is August 31, 2021. The license status is ACTIVE.
SUSAN D BOULWARE MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.028443. The credential type is physician/surgeon. The effective date is September 1, 2020. The expiration date is August 31, 2021. The business address is 100 Randi Drive, Madison, CT 06443. The current status is active.
| Licensee Name | SUSAN D BOULWARE MD |
| Business Name | YALE UNIV DEPT OF PEDIATRICS |
| Credential ID | 547168 |
| Credential Number | 1.028443 |
| Credential Type | Physician/Surgeon |
| Business Address |
100 Randi Drive Madison CT 06443 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1987-08-21 |
| Effective Date | 2020-09-01 |
| Expiration Date | 2021-08-31 |
| Refresh Date | 2020-06-02 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 157894 | CSP.0019746 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1999-03-01 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 100 RANDI DRIVE |
| City | MADISON |
| State | CT |
| Zip Code | 06443 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Caitlyn Beverly Darosa | Lyle Dr, Madison, CT 06443 | Registered Nurse | ~ |
| Roberts Food Center · Rjf Inc Dba | 514 Old Toll Rd, Madison, CT 06443 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Karen D Leonetti · Rapuano | 553 Green Hill Rd, Madison, CT 06443 | Radiographer | 2020-09-01 ~ 2021-08-31 |
| Pasquale Sabatasso | 122 River Edge Farms Road, Madison, CT 06443 | Barber | 2020-07-01 ~ 2022-06-30 |
| Madision Health Foods · Jum Ok Coker | 59 Wall St, Madison, CT 06443 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Madison Community Services Inc. | P.o. Box 148, Madison, CT 06443 | Public Charity | 2020-12-01 ~ 2021-11-30 |
| Shaina Michele Levinson | 52 East Wharf Rd, Madison, CT 06443 | Master's Level Social Worker | ~ |
| Stephen G Lynch · Lynch, Stephen Gerard | 12 Milestone Lane, Madison, CT 06443 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| David F Courtney Md | 38 Old Duck Hole Road, Madison, CT 06443 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Sydni E Marmor | 560 Opening Hill Road, Madison, CT 06443 | Professional Counselor | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06443 | |||
| City | MADISON |
| Zip Code | 06443 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + MADISON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Rodrigo Nehgme Md · Yale Univ Dept of Pediatrics | Yale Univ School of Medicine, New Haven, CT 06520 | Physician/surgeon | 2005-03-11 ~ 2006-04-30 |
| M Susan Moyer Md · Yale Univ School of Medicine | Dept of Pediatrics, New Haven, CT 06520-8064 | Physician/surgeon | 2002-12-24 ~ 2004-02-29 |
| Laura R Ment Md · Yale Univ Dept of Pediatrics | Yale Univ Dept of Pediatrics, School of Medicine, New Haven, CT 06520-8064 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Ramsay Fuleihan Md · Yale Univ Dept of Pediatrics | Yale School of Medicine, New Haven, CT 06520-8064 | Physician/surgeon | 2006-09-22 ~ 2007-11-30 |
| Gabriel G Haddad Md · Yale Univ Dept of Pediatrics | Yale School of Medicine, New Haven, CT 06510 | Physician/surgeon | 2002-02-19 ~ 2003-03-31 |
| Peter Hotez Md | Yale Univ Dept of Pediatrics, New Haven, CT 06520 | Physician/surgeon | 2003-04-24 ~ 2004-05-31 |
| Thomas O Carpenter Md | Yale Univ Sch of Med Dept of Pediatrics, New Haven, CT 06520-8064 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Michael Cappello Md | Yale Univ Dept of Pediatrics, New Haven, CT 06520-8081 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Sharon Zemel Md · Yale Univ Dept of Pediatrics | 333 Cedar St, New Haven, CT 06520-8064 | Physician/surgeon | 1999-04-26 ~ 2000-06-30 |
| Ruth Whittemore Md · Yale Univ Dept of Pediatrics | 333 Cedar St, New Haven, CT 06510 | Physician/surgeon | 1998-09-28 ~ 1999-06-30 |
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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).