Provider Demographics
NPI:1003129446
Name:BUTANI, VIKRAM RJ
Entity Type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:RJ
Last Name:BUTANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W SQUANTUM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2122
Mailing Address - Country:US
Mailing Address - Phone:617-376-3000
Mailing Address - Fax:617-774-1905
Practice Address - Street 1:110 W SQUANTUM ST
Practice Address - Street 2:
Practice Address - City:NORTH QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2122
Practice Address - Country:US
Practice Address - Phone:617-376-3000
Practice Address - Fax:617-774-1905
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine