Provider Demographics
NPI:1073179297
Name:BUTLER, MARY MICHELE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MICHELE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:283 CONSTITUTION DR STE 600
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6760
Mailing Address - Country:US
Mailing Address - Phone:509-201-1487
Mailing Address - Fax:855-771-0248
Practice Address - Street 1:283 CONSTITUTION DR STE 600
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6760
Practice Address - Country:US
Practice Address - Phone:757-250-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101276240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine