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General NPI Number Information
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NPI Number | 1932012580
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Entity Type | Organization
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Legal Business Name | BOULOUTE PODIATRY SERVICES, LLC
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 10004 GAINSBOROUGH RD
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City | POTOMAC
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State | MD
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Zip | 20854-4275
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Country | US
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Telephone | 833-633-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 451 HUNGERFORD DR STE 119
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City | ROCKVILLE
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State | MD
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Zip | 20850-5148
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Country | US
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Telephone | 833-633-3668
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Fax | 833-633-3668
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Authorized Official
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Title or Position | OWNER
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Name | DR. OWMY BOULOUTE
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Credential | DPM
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Telephone | 833-633-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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