# PHILIP CHARLES BOULANGER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144429564
- **Authorized official:** PHILIP CHARLES BOULANGER M.D. (OWNER/PRESIDENT)
- **Authorized official phone:** (804) 389-2606

## Contact information

- **Practice address:** 9401 FERNLEIGH DR, RICHMOND, VA 23235-1311
- **Practice address phone:** (804) 389-2606
- **Practice address fax:** (804) 747-0643
- **Mailing address:** 9401 FERNLEIGH DR, RICHMOND, VA 23235-1311
- **Mailing address phone:** (804) 389-2606
- **Mailing address fax:** (804) 747-0643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/16/2007
- **Last updated:** 06/26/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 190001514 | MEDICARE GROUP\# | VA |