Individual
DR. JOHN WILLIAM BOULDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1802 BRAEBURN DR, SALEM, VA 24153-7357
(540) 772-3580
(540) 725-5012
Mailing address
1802 BRAEBURN DR, SALEM, VA 24153-7357
(540) 772-3580
(540) 725-5012
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101055716
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386624930
—
VA
01
—
281202
AMERIGROUP
VA
05
—
6701302
—
VA
Enumeration date
01/19/2006
Last updated
04/21/2026
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