Active NPI
Maria Boulos
- Pediatric Radiology Physician
- Latham, NY
National Provider Identifier
1801973771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Radiology Physician
- License
- 211666
- Practice address
- 711 Troy Schenectady Rd
Suite 114
Latham, NY 12110-2442 - Phone
- (518) 786-1600
- NPI assigned
- Oct 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Radiology Physician | 2085P0229X | 211666 | NY | Primary |
| Diagnostic Radiology Physician | 2085R0202X | 211666 | NY |
Addresses
Primary practice location
711 Troy Schenectady Rd
Suite 114
Latham, NY 12110-2442
Mailing address
711 Troy Schenectady Rd
Suite 201
Latham, NY 12110-2442
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01991033 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Care Physicians, PC | Past | Accepting new patients | |
| Albany Medical Center South Clinical Campus | Pediatric Radiology | Past | Accepting new patients |
| Albany Medical Center Hospital | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Albany, NY
- NPI 1811917461
-
- Diagnostic Ultrasound Physician
- Albany, NY
- NPI 1669408332
Pediatric Radiology
-
- Internal Medicine Physician
- Latham, NY
- NPI 1023380714
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323129600000",
"number": "1801973771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 TROY SCHENECTADY RD",
"address_2": "SUITE 201",
"city": "LATHAM",
"state": "NY",
"postal_code": "121102442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 TROY SCHENECTADY RD",
"address_2": "SUITE 114",
"city": "LATHAM",
"state": "NY",
"postal_code": "121102442",
"telephone_number": "518-786-1600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULOS",
"first_name": "MARIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-31",
"last_updated": "2011-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "2085P0229X",
"taxonomy_group": "",
"desc": "Radiology, Pediatric Radiology",
"state": "NY",
"license": "211666",
"primary": true
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NY",
"license": "211666",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01991033",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Latham, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.