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NPI Code Detail

MEDICARE: FOUAD S BOULOS MD

MEDICARE: FOUAD S BOULOS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician169814NY
2207R00000XInternal Medicine Physician169814NY

General Provider Information

NPI Number : 1366445652
Entity Type Code : Individual
Provider Name (Legal Business Name) : FOUAD S BOULOS MD
Provider Business Mailing Address
First Line : 1001 W FAYETTE ST
Second Line : SUITE 400
City : SYRACUSE
State : NY
Zip : 13204-2859
Country : US
Telephone Number : 315-472-1488
Fax Number : 315-472-8060
Provider Business Practice Location Address
First Line : 736 IRVING AVE
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-1687
Country : US
Telephone Number : 315-410-7411
Fax Number : 315-470-2693
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 06/12/2008

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Directions to “ FOUAD S BOULOS MD” Practice Location

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