Provider Demographics
NPI:1992875744
Name:BOUDREAU, REGIS JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:REGIS
Middle Name:JOSEPH
Last Name:BOUDREAU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1245
Mailing Address - Country:US
Mailing Address - Phone:617-244-3831
Mailing Address - Fax:617-244-5203
Practice Address - Street 1:1159 NORTH RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:MA
Practice Address - Zip Code:01741-1245
Practice Address - Country:US
Practice Address - Phone:617-244-3831
Practice Address - Fax:617-244-5203
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1922213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
470920Medicare ID - Type Unspecified
T97454Medicare UPIN