Individual
DR. DANY BOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11000 ROOSEVELT BLVD, 360, PHILADELPHIA, PA 19116-3961
(215) 677-1475
(215) 677-3082
Mailing address
PO BOX 820933, PHILADELPHIA, PA 19182-0933
(215) 926-9010
(215) 226-8685
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036141752
IL
207Q00000X
Family Medicine Physician
01068800A
IN
207Q00000X
Family Medicine Physician
Primary
036141752
IL
207Q00000X
Family Medicine Physician
MD453720
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000718849
ANTHEM
IN
01
—
036141752
STATE LICENSE
IL
05
—
201024290
—
IN
Enumeration date
08/11/2008
Last updated
03/20/2024
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