Individual
GEMILA H BOUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
(434) 296-9161
Mailing address
1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
(340) 296-4916
(585) 336-4845
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101246875
VA
208000000X
Pediatrics Physician
221757
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026563702
UNIVERA
NY
05
—
00355266
—
NY
01
—
050607000034
FIDELIS
NY
01
—
109767DL
PREFERRED CARE
NY
01
—
11121694
CAQH
NY
01
—
1292712
IHA
NY
01
—
P010221757
BLUE CHOICE
NY
Enumeration date
05/02/2006
Last updated
05/10/2024
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