Provider Demographics
NPI:1013006261
Name:BOOSALIS, VALIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:VALIA
Middle Name:A
Last Name:BOOSALIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VASSILIKI
Other - Middle Name:ANTONOPOULOU
Other - Last Name:BOOSALIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:150 S HUNTINGTON AVE # S
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:617-232-9500
Mailing Address - Fax:617-738-1450
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:IIIHO
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:617-232-9500
Practice Address - Fax:617-738-1450
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77958207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology