Individual
IMHOTEP BOUKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 SENTARA CIR RM 2C, WILLIAMSBURG, VA 23188-5713
(757) 984-7217
(757) 984-7210
Mailing address
100 SENTARA CIR RM 2C, WILLIAMSBURG, VA 23188-5713
(757) 984-7217
(757) 984-7210
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101263610
VA
207R00000X
Internal Medicine Physician
MD418363
PA
208M00000X
Hospitalist Physician
0101263610
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001901656
—
PA
Enumeration date
05/26/2006
Last updated
08/03/2020
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