Basic Information
| Provider Information | |||||||||
| NPI: | 1689290553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOUFFARD | ||||||||
| FirstName: | SARAH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1770 BATHGATE RD STE 402 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8488488950 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 S CEDAR CREST BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104026555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2020 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA061591 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.