Provider Demographics
NPI:1003831629
Name:BUTCHER, BRIAN K (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:895 CITY CENTER BLVD 200
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3080
Mailing Address - Country:US
Mailing Address - Phone:757-599-4090
Mailing Address - Fax:
Practice Address - Street 1:11835 FISHING POINT DR
Practice Address - Street 2:STE 207
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-873-3334
Practice Address - Fax:757-873-1128
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012258202080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006712240Medicaid
H16298Medicare UPIN