MEDICARE: REGIS BOUDREAU DPM LLC

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	213E00000X	Podiatrist		MA

General Provider Information

NPI Number	:	1922468511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIS BOUDREAU DPM LLC

Provider Business Mailing Address
First Line	:	1159 NORTH RD
Second Line	:
City	:	CARLISLE
State	:	MA
Zip	:	01741-1245
Country	:	US
Telephone Number	:	617-244-3831
Fax Number	:	617-244-5203

Provider Business Practice Location Address
First Line	:	1159 NORTH RD
Second Line	:
City	:	CARLISLE
State	:	MA
Zip	:	01741-1245
Country	:	US
Telephone Number	:	617-244-3831
Fax Number	:	617-244-5203

Authorized Official
Title or Position	:	OWNER
Name	:	DR. REGIS JOSEPH BOUDREAU
Credential	:	D.P.M.
Telephone Number	:	617-244-3831

Provider Enumeration Date	:	02/25/2016
Last Update Date	:	02/13/2025

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