Michael Steven Boulos, | |
90 Brick Rd Fl 3, Marlton, NJ 08053-2177 | |
(856) 355-6000 | |
(856) 355-6731 |
Full Name | Michael Steven Boulos |
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Gender | Male |
Speciality | Hospitalist |
Location | 90 Brick Rd Fl 3, Marlton, New Jersey |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1326608365 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208M00000X | Hospitalist | 25MA11518400 (New Jersey) | Primary |
208M00000X | Hospitalist | MD478494 (Pennsylvania) | Secondary |
Entity Name | Virtua Medical Group, Pa |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1649226515 PECOS PAC ID: 9830222397 Enrollment ID: O20100804000338 |
Mailing Address | Practice Location Address |
---|---|
Michael Steven Boulos, 301 Lippincott Dr Ste 410, Marlton, NJ 08053-4197 Ph: (856) 355-6000 | Michael Steven Boulos, 90 Brick Rd Fl 3, Marlton, NJ 08053-2177 Ph: (856) 355-6000 |
Marrian Sedrak, DO Hospitalist Medicare: Medicare Enrolled Practice Location: 90 Brick Rd Fl 3, Marlton, NJ 08053 Phone: 856-355-6000 | |
David Arveladze, MD Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 90 Brick Rd Fl 3, Marlton, NJ 08053 Phone: 856-355-6000 | |
Heather M. Giannini, M.D. Hospitalist Medicare: Medicare Enrolled Practice Location: Renaissance Square., 141 Route 70, Suite B, Marlton, NJ 08053 Phone: 856-596-9057 Fax: 856-596-0837 | |
Shapour Steve Mirmanesh, M.D. Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 12000 Lincoln Drive West, Suite 405, Marlton, NJ 08053 Phone: 856-985-0203 Fax: 856-985-0010 | |
Lucinda Fisher, M.D. Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 90 Brick Rd Fl 3, Marlton, NJ 08053 Phone: 856-355-6000 Fax: 856-355-6731 | |
Ali M Mustafa, Hospitalist Medicare: Not Enrolled in Medicare Practice Location: Renaissance Square, 141 Route 70, Suite B, Marlton, NJ 08053 Phone: 856-596-9057 Fax: 856-596-0837 |