Individual
DR. CHARLES BOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 E MAIN ST, MIDDLETOWN, NY 10940
(845) 333-1445
Mailing address
11781 LEE JACKSON MEMORIAL HWY, SUITE 550, FAIRFAX, VA 22033-3309
(571) 777-5173
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
142072
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00543302
—
NY
05
—
01543302
—
NY
01
—
P01229245
RAILROAD MEDICARE
NY
Enumeration date
11/21/2005
Last updated
08/14/2015
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