Provider Demographics
NPI:1457483109
Name:BOULWARE, VALERIE H (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:H
Last Name:BOULWARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 FIVE MILE CENTRE PARK
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-5516
Mailing Address - Country:US
Mailing Address - Phone:540-548-2960
Mailing Address - Fax:540-548-2961
Practice Address - Street 1:6330 FIVE MILE CENTRE PARK
Practice Address - Street 2:SUITE 400
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-5516
Practice Address - Country:US
Practice Address - Phone:540-548-2960
Practice Address - Fax:540-548-2961
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012366142084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry