Individual
DR. SUSAN B BOUTILIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2280 HEMBY LN, GREENVILLE, NC 27834-3773
(252) 744-9400
(252) 744-9401
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
9701256
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1122N
BCBSNC
NC
05
—
1558368936
—
NC
01
—
370011207
RAILROAD MEDICARE
NC
Enumeration date
06/30/2005
Last updated
02/01/2024
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