Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | D72644 | MD |
N | 207X00000X | Orthopaedic Surgeon | L-224770 | MA |
N | 207XS0117X | Orthopaedic Spine Surgeon | D72644 | MD |
NPI | 1366563785 |
---|---|
Provider Name | Christina Louise Boulton |
First Address | Baltimore, MD 21201-1544 |
Second Address | Baltimore, MD 21201-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 25/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D72644 | LISENCE (01) | MD |