Provider Demographics
NPI:1912105495
Name:BOUTROS, CHERIF (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERIF
Middle Name:
Last Name:BOUTROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ENGLE ST STE 6501
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1808
Mailing Address - Country:US
Mailing Address - Phone:201-608-2800
Mailing Address - Fax:410-787-4846
Practice Address - Street 1:350 ENGLE ST STE 6501
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-608-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00709652086X0206X
NJ25MA122033002086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD238612OtherJOHNS HOPKINS HEALTHCARE
MD034615200Medicaid
MDP00893238OtherMEDICARE RAIL ROAD
MD967368-02OtherCAREFIRST RENDERING NUMBER
MDQ818-0022OtherCAREFIRST GROUP
MDGROUP PTAN:DQ7486OtherMEDICARE RAIL ROAD
MDP00893238OtherMEDICARE RAIL ROAD