MEDICARE: LAWRENCE F BOUCHARD MD

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	207Q00000X	Family Medicine Physician	35-04-6863	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9338635	OTHER	OH	MEDICARE GROUP NUMBER
3	1841239274	OTHER	OH	MEDICARE/MEDICAID GROUP NPI #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1548207111	OTHER	OH	NPI GROUP NUMBER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427038157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE F BOUCHARD MD

Provider Business Mailing Address
First Line	:	676 S BROADWAY ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1059
Country	:	US
Telephone Number	:	330-344-4000
Fax Number	:	330-253-2349

Provider Business Practice Location Address
First Line	:	676 S BROADWAY ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1059
Country	:	US
Telephone Number	:	330-344-4000
Fax Number	:	330-253-2349

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	09/22/2010

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Directions to “ LAWRENCE F BOUCHARD MD” Practice Location

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