Provider Demographics
NPI:1316059587
Name:BOULIER, IRMINA CHAO (MD)
Entity type:Individual
Prefix:DR
First Name:IRMINA
Middle Name:CHAO
Last Name:BOULIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 FINNEGAN DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2575
Mailing Address - Country:US
Mailing Address - Phone:410-544-1926
Mailing Address - Fax:410-315-8147
Practice Address - Street 1:251 FINNEGAN DR
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2575
Practice Address - Country:US
Practice Address - Phone:410-544-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44202207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF63622Medicare UPIN