Provider Demographics
NPI:1184858219
Name:BOUTRUS, RIMOUN RAMSIS ANIS
Entity Type:Individual
Prefix:
First Name:RIMOUN
Middle Name:RAMSIS ANIS
Last Name:BOUTRUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 NORWEST DR
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-1484
Mailing Address - Country:US
Mailing Address - Phone:508-596-6419
Mailing Address - Fax:
Practice Address - Street 1:10 EMERSON PL
Practice Address - Street 2:SUITE 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2204
Practice Address - Country:US
Practice Address - Phone:617-724-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program