Provider Demographics
NPI:1710157086
Name:PAULA E BOURELLY MD & ASSOC
Entity Type:Organization
Organization Name:PAULA E BOURELLY MD & ASSOC
Other - Org Name:OLNEY DERMATOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:BOURELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-260-9202
Mailing Address - Street 1:18111 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE123
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1513
Mailing Address - Country:US
Mailing Address - Phone:301-260-9202
Mailing Address - Fax:301-260-9201
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:SUITE123
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-260-9202
Practice Address - Fax:301-260-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052140207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01951Medicare UPIN