Individual
GRIGORII GENNADIYOUYCH BOULDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
40 LAMBERT ST, STAUNTON, VA 24401-2446
(540) 885-3525
(540) 886-5935
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0116025455
VA
Other
Enumeration date
06/18/2012
Last updated
09/05/2023
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