Individual
DR. MATTHEW STEPHEN BOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
11640 NORTHPARK DR STE 100, WAKE FOREST, NC 27587-5741
(919) 366-7759
Mailing address
11640 NORTHPARK DR STE 100, WAKE FOREST, NC 27587-5741
(919) 366-7759
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2018-00732
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/04/2015
Last updated
01/09/2024
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