Provider Demographics
NPI:1073515045
Name:BUTLER, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9544
Mailing Address - Country:US
Mailing Address - Phone:856-596-7440
Mailing Address - Fax:856-596-6723
Practice Address - Street 1:502 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9544
Practice Address - Country:US
Practice Address - Phone:856-596-7440
Practice Address - Fax:856-596-6723
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02489000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2424401Medicaid
NJ471100Medicare ID - Type Unspecified
NJ2424401Medicaid