Provider Demographics
NPI:1104490366
Name:BOUTROS-KHOURY, HANNAH (MD)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:
Last Name:BOUTROS-KHOURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HANNAH
Other - Middle Name:THERESE
Other - Last Name:BOUTROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7011 FAYETTEVILLE RD STE 210
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7745
Practice Address - Country:US
Practice Address - Phone:919-806-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-00660208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty