MEDICARE: COREY CRAIG BOUSQUET PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9102466	FL
2	363A00000X	Physician Assistant	2478	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	291035	OTHER	FL	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598717571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY CRAIG BOUSQUET PA-C

Provider Business Mailing Address
First Line	:	45 MALER AVE
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-5925
Country	:	US
Telephone Number	:	305-528-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1918 BLACK ROCK TPKE
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-3543
Country	:	US
Telephone Number	:	203-583-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	01/25/2024

Similar Medicare Providers

1295830040 — CONNECTICUT CVS PHARMACY LLC
Practice Location Address:

1968 BLACK ROCK TPKE , FAIRWAY PLAZA
FAIRFIELD, CT
06825-3543

Practice Phone: 203-366-8070
Practice Fax:

1841500675 — NICOLLE E WHITE PA-C
Practice Location Address:

1918 BLACK ROCK TPKE
FAIRFIELD, CT
06825-3543

Practice Phone: 203-583-8400
Practice Fax:

1437546363 — QMG2,LLC
Practice Location Address:

1910 BLACK ROCK TPKE
FAIRFIELD, CT
06825-3543

Practice Phone: 203-333-4400
Practice Fax: 203-292-7026

1477917516 — MR. KENNETH H LEE
Practice Location Address:

1968 BLACK ROCK TPKE
FAIRFIELD, CT
06825-3543

Practice Phone: 203-366-8070
Practice Fax: 203-335-2132

1447604129 — RALPH MOCCIOLA
Practice Location Address:

1968 BLACK ROCK TPKE
FAIRFIELD, CT
06825-3543

Practice Phone: 203-366-8070
Practice Fax: 203-335-2132

1669998829 — IREGI FRANCIS PHARMD
Practice Location Address:

1968 BLACK ROCK TPKE
FAIRFIELD, CT
06825-3543

Practice Phone: 203-366-8070
Practice Fax:

Directions to “ COREY CRAIG BOUSQUET PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.