Healthcare Provider Details

I. General information

NPI: 1104490366
Provider Name (Legal Business Name): HANNAH BOUTROS-KHOURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANNAH THERESE BOUTROS MD

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 11/07/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 FAYETTEVILLE RD STE 210
DURHAM NC
27713-7745
US

IV. Provider business mailing address

5221 PARAMOUNT PKWY STE 220
MORRISVILLE NC
27560-5490
US

V. Phone/Fax

Practice location:
  • Phone: 919-806-3335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024-00660
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: