MEDICARE: DR. GEORGE BOUDOURIS PSYD

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
1	103TC0700X	Clinical Psychologist	0810002895	VA

General Provider Information

NPI Number	:	1447280383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE BOUDOURIS PSYD

Provider Business Mailing Address
First Line	:	5243 PARK RIDGE CT
Second Line	:
City	:	CROZET
State	:	VA
Zip	:	22932-3162
Country	:	US
Telephone Number	:	434-825-4878
Fax Number	:

Provider Business Practice Location Address
First Line	:	5243 PARK RIDGE CT
Second Line	:
City	:	CROZET
State	:	VA
Zip	:	22932-3162
Country	:	US
Telephone Number	:	434-825-4878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	02/11/2025

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