Provider Demographics
NPI:1336116979
Name:BUTTERWORTH, GREG A (O D)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:A
Last Name:BUTTERWORTH
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:920 REVOLUTION ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3748
Practice Address - Country:US
Practice Address - Phone:410-939-2200
Practice Address - Fax:410-939-5980
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00376361OtherMEDICARE RAILROAD
U84784Medicare UPIN
138139YN2CMedicare PIN
P00376361OtherMEDICARE RAILROAD
237LO249Medicare PIN