MICHAEL BOURQUE MD NPI 1518939321

NPI Information

NPI: 1518939321
Provider Name: MICHAEL BOURQUE, MD
Classification: Surgery - 2086S0120X
Entity Type: Individual

Specialization: Pediatric Surgery

PECOS Registration: Yes

Address:
282 WASHINGTON ST
HARTFORD, CT
ZIP 06106
Phone: (860) 545-9520
Get Directions

Michael Bourque, MD is a pediatric surgery surgery in Hartford, CT. The provider is a surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. Michael Bourque, MD NPI is 1518939321. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

282 WASHINGTON ST
HARTFORD, CT
ZIP 06106-322
Phone: (860) 545-9520
Fax: (860) 545-9545

The NPI 1518939321 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/6/2006 and was last updated on 11/4/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208600000X	Surgery		029964	CONNECTICUT	No
2	2086S0120X	Surgery	Pediatric Surgery	029964	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	E32401	MEDICARE UPIN	CONNECTICUT
2	370001465	MEDICARE ID-TYPE UNSPECIFIED	CONNECTICUT
3	001299644	MEDICAID	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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