Organization
BOULOUTE HEALTHCARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OWMY BOULOUTE DPM (OWNER)
(678) 517-4214
Entity
Organization
Contact information
Practice address
5049 ANCHORSTONE DR, WOODBRIDGE, VA 22192-8320
(678) 517-4214
Mailing address
8653 16TH ST UNIT 7186, SILVER SPRING, MD 20907-7909
(678) 517-4214
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
01303301212
VA
Other
Enumeration date
08/25/2017
Last updated
08/25/2017
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