SUSAN DIANE BOULWARE (NPI# 1124001946) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124001946 |
| Entity Type | Individual |
| Full Name | SUSAN DIANE BOULWARE |
| Credential | MD |
| Practice Address |
2 Church St S Suite 511 New Haven CT 06519-1717 |
| Mailing Address |
300 George St 6th Floor New Haven CT 06536-0805 |
| Practice Telephone | 2037649199 |
| Practice Fax Number | 2037649149 |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2008-08-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0205X |
Pediatrics Specialization: Pediatric Endocrinology |
028443 | CT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 001284439 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326254343 | Susan Laura Boulware | Psychoanalyst | 2609 Capitol Ave, Sacramento, CA 95816-5904 | 2007-05-15 |
| Street Address |
2 CHURCH ST S SUITE 511 |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06519-1717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093710295 | David Kusovitsky | Dentist | 2 Church St S, Ste 216, New Haven, CT 06519-1717 | 2005-06-15 |
| 1932519311 | Caroline Anne Nelson | Dermatology | 2 Church St S, New Haven, CT 06519-1717 | 2014-05-06 |
| 1730439548 | New Haven Prosthodontics, PC | Dentist | 2 Church St S, Suite 216, New Haven, CT 06519-1717 | 2012-09-19 |
| 1720336415 | Hammers Healthcare Imaging, LLC | Radiology | 2 Church St S, Suite 110, New Haven, CT 06519-1717 | 2012-08-28 |
| 1629353016 | Rajita Sinha | Psychologist | 2 Church St S, Suite 209, New Haven, CT 06519-1717 | 2011-10-17 |
| 1417250945 | Interpace Diagnostics Lab, Inc. | Clinical Medical Laboratory | 2 Church St S, Suite B-05, New Haven, CT 06519-1717 | 2010-12-06 |
| 1205137783 | Roslyn Chosak M.d.,l.l.c. | Specialist | 2 Church St S, Suite 501, New Haven, CT 06519-1717 | 2010-11-15 |
| 1235468711 | Robert F Berke-schlessel | Surgery | 2 Church St S, Suite 504, New Haven, CT 06519-1717 | 2009-12-14 |
| 1770817991 | Sachin N Desai | Pediatrics | 2 Church St S, Suite 300a, New Haven, CT 06519-1717 | 2009-09-21 |
| 1063654945 | Anne M Lovejoy | Physician Assistant | 2 Church St S, Suite 515, New Haven, CT 06519-1717 | 2009-03-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255819348 | Jordan Ficocelli | Nurse Practitioner | 800 Howard Ave # 2, New Haven, CT 06519 | 2018-08-01 |
| 1780123414 | Claire Louise Hardin | General Acute Care Hospital | 95 Howard Ave, New Haven, CT 06519 | 2017-02-14 |
| 1467809137 | Ana Laura Vives-rodriguez | Student in an Organized Health Care Education/Training Program | 800 Howard Avenue, Lower Level, Yale Physicians Building, New Haven, CT 06519 | 2016-05-23 |
| 1346607785 | Amanda Kayte Corcoran | Advanced Practice Midwife | 40 Prince St., Suite 207, New Haven, CT 06519 | 2016-01-15 |
| 1720491905 | Sara Harcharik Perkins | Dermatology | 2 Church St S Ste 305, New Haven, CT 06519 | 2014-06-05 |
| 1194136713 | Krishan Ratilal Jethwa | Radiology | 35 Park St Ste Ll507, New Haven, CT 06519 | 2014-05-16 |
| 1235549353 | Brandon Michael Kitay | Psychiatry & Neurology | 184 Liberty St # Lv108, New Haven, CT 06519 | 2014-04-28 |
| 1649526617 | Yale New Haven Hospital | Student in an Organized Health Care Education/Training Program | 330 Cedar St Fmb 107, Yale New Haven Hospital, Dept of Surgery, New Haven, CT 06519 | 2012-07-27 |
| 1669736765 | Mayanka Tickoo | Internal Medicine | 300 Cedar St Fl 4, New Haven, CT 06519 | 2012-07-03 |
| 1730441627 | Judith A Ross | Physical Therapist | 18 Tower Lane, Tower One Tower East, New Haven, CT 06519 | 2012-06-15 |
| Find all providers in zip 06519 | ||||
| Taxonomy Code | 2080P0205X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Endocrinology |
| A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region and disorders of the thyroid, the adrenal and pituitary glands. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174720957 | Stephan Siebel | Pediatrics | 330 Cedar St # 3103, New Haven, CT 06510-3218 | 2007-06-27 |
| 1417300203 | Apoorva Ravindranath Waikar | Pediatrics | 20 York St Dept Of, New Haven, CT 06510-3220 | 2016-07-18 |
| 1578975488 | Kelly Joseph | Pediatrics | 20 York St, New Haven, CT 06510-3220 | 2014-05-27 |
| 1376986711 | Jennifer Sarhis Avigdor | Pediatrics | 20 York St, Ynhh Dept Pediatric Endocrinology, New Haven, CT 06510-3220 | 2013-04-16 |
| 1194084541 | Stephanie Lynn Samuels | Pediatrics | 1 Park St, New Haven, CT 06504-8901 | 2012-05-04 |
| 1346521531 | Lisa Michelle Cruz-aviles | Pediatrics | 20 York St, New Haven, CT 06510-3220 | 2011-09-01 |
| 1265738389 | Cemre Robinson | Pediatrics | 15 York St, New Haven, CT 06510-3221 | 2011-02-07 |
| 1851628358 | Anisha D. Patel | Pediatrics | 1 Long Wharf Dr, 2nd Floor, New Haven, CT 06511-5991 | 2009-11-04 |
| 1811163363 | Michelle Anne Van Name | Pediatrics | 1 Long Wharf Dr, Suite 503, New Haven, CT 06511-5991 | 2008-05-05 |
| 1851581045 | Eda Cengiz | Pediatrics | 333 Cedar St, Lmp 3103, New Haven, CT 06510-3206 | 2007-07-25 |
| Find all providers in NEW HAVEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.