Provider Demographics
NPI:1679531479
Name:BOUBER, GEMILA H (MD)
Entity Type:Individual
Prefix:
First Name:GEMILA
Middle Name:H
Last Name:BOUBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEMILA
Other - Middle Name:
Other - Last Name:HASSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5354
Mailing Address - Country:US
Mailing Address - Phone:340-296-4916
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:1011 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5354
Practice Address - Country:US
Practice Address - Phone:434-296-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246875208000000X
NY221757208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050607000034OtherFIDELIS
NY109767DLOtherPREFERRED CARE
NY00355266Medicaid
NY1292712OtherIHA
NY00026563702OtherUNIVERA
NYP010221757OtherBLUE CHOICE
NY11121694OtherCAQH
NY00355266Medicaid