Organization
PHILIP CHARLES BOULANGER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP CHARLES BOULANGER M.D. (OWNER/PRESIDENT)
(804) 389-2606
Entity
Organization
Contact information
Practice address
9401 FERNLEIGH DR, RICHMOND, VA 23235-1311
(804) 389-2606
(804) 747-0643
Mailing address
9401 FERNLEIGH DR, RICHMOND, VA 23235-1311
(804) 389-2606
(804) 747-0643
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190001514
MEDICARE GROUP#
VA
Enumeration date
07/16/2007
Last updated
06/26/2008
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