Provider Demographics
NPI:1992700967
Name:BOULTER, SUZANNE C (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:C
Last Name:BOULTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:250 PLEASANT ST.
Mailing Address - Street 2:YEAPLE BUILDING
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-228-7200
Mailing Address - Fax:603-228-7307
Practice Address - Street 1:250 PLEASANT ST.
Practice Address - Street 2:YEAPLE BUILDING
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-228-7200
Practice Address - Fax:603-228-7307
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4811208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH371516OtherMVP HEALTHCARE
NH3016636OtherAETNA
NH2553OtherCIGNA
NHH005016OtherTRICARE
NH361Medicaid
NHD78744OtherHARVARD PILGRIM HEALTHCAR
NHD78744OtherHARVARD PILGRIM HEALTHCAR
NH371516OtherMVP HEALTHCARE