Individual
MARIA BOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
711 TROY SCHENECTADY RD, SUITE 114, LATHAM, NY 12110-2442
(518) 786-1600
Mailing address
711 TROY SCHENECTADY RD, SUITE 201, LATHAM, NY 12110-2442
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
211666
NY
2085R0202X
Diagnostic Radiology Physician
211666
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01991033
—
NY
Enumeration date
10/31/2006
Last updated
12/06/2011
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