Healthcare Provider Details

I. General information

NPI: 1548720303
Provider Name (Legal Business Name): CAMILLE BOUSTANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 SURRATTS RD STE 203
CLINTON MD
20735-3362
US

IV. Provider business mailing address

7501 SURRATTS RD STE 203
CLINTON MD
20735-3362
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0103867
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0103867
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: