Provider Demographics
NPI:1235192949
Name:BUTANEY, EDNA CA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:CA
Last Name:BUTANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EDNA
Other - Middle Name:C
Other - Last Name:ANGELES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:388 COMMONWEALTH AVE
Mailing Address - Street 2:UNIT B2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2800
Mailing Address - Country:US
Mailing Address - Phone:617-262-2416
Mailing Address - Fax:617-262-2436
Practice Address - Street 1:388 COMMONWEALTH AVE
Practice Address - Street 2:UNIT B2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2800
Practice Address - Country:US
Practice Address - Phone:617-262-2416
Practice Address - Fax:617-262-2436
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine