Healthcare Provider Details

I. General information

NPI: 1477936250
Provider Name (Legal Business Name): OLIVIA BOUCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 YORK ROAD
BUCKINGHAM PA
18912-0278
US

IV. Provider business mailing address

PO BOX 829641
PHILADELPHIA PA
19182-9641
US

V. Phone/Fax

Practice location:
  • Phone: 215-794-7471
  • Fax: 215-794-2576
Mailing address:
  • Phone: 267-370-5285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD488741
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: