Provider Demographics
NPI:1114445368
Name:BUTT, ZACHARY D (CRNP)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:D
Last Name:BUTT
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-0020
Mailing Address - Country:US
Mailing Address - Phone:301-371-9000
Mailing Address - Fax:301-371-8905
Practice Address - Street 1:300 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-8043
Practice Address - Country:US
Practice Address - Phone:301-371-9000
Practice Address - Fax:301-371-8905
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily