Healthcare Provider Details

I. General information

NPI: 1851652770
Provider Name (Legal Business Name): SCARLETT BOULOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 03/06/2024
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 WEST LOOP SOUTH SUITE #500
BELLAIRE TX
77401
US

IV. Provider business mailing address

6700 WEST LOOP SOUTH SUITE #500
BELLAIRE TX
77401
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-9966
  • Fax: 713-791-9966
Mailing address:
  • Phone: 713-791-9966
  • Fax: 713-791-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number252075
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD457211
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: