Provider Demographics
NPI:1326043589
Name:BUTOI, DAN STEFAN (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:STEFAN
Last Name:BUTOI
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 1:500 FOWLER AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-3326
Mailing Address - Country:US
Mailing Address - Phone:570-752-2349
Mailing Address - Fax:570-752-6959
Practice Address - Street 1:500 FOWLER AVE
Practice Address - Street 2:STE 202
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3326
Practice Address - Country:US
Practice Address - Phone:570-752-2349
Practice Address - Fax:570-752-6959
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038649L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008640010010Medicaid
PAC29038Medicare UPIN
PA073730Medicare ID - Type Unspecified