Provider Demographics
NPI:1184086613
Name:BOULDIN, MERYLL ELLEN PAMPOLINA (MD)
Entity type:Individual
Prefix:
First Name:MERYLL
Middle Name:ELLEN PAMPOLINA
Last Name:BOULDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MERYLL
Other - Middle Name:ELLEN
Other - Last Name:PAMPOLINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:4301 WEST MARKHAM, SLOT 584
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7199
Practice Address - Country:US
Practice Address - Phone:501-526-2085
Practice Address - Fax:501-320-7068
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11841207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine