Provider Demographics
NPI:1336117357
Name:BUTLER, KARYN L (MD)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:L
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 HIGHLAND AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3724
Mailing Address - Country:US
Mailing Address - Phone:215-481-7463
Mailing Address - Fax:215-481-2159
Practice Address - Street 1:1245 HIGHLAND AVE STE 302
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001
Practice Address - Country:US
Practice Address - Phone:215-481-7462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0841842086S0102X, 2086S0127X
CT0469852086S0102X
PAMD4639002086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001469857Medicaid
OH2479045Medicaid
OHF55963Medicare UPIN
OHBU4131922Medicare ID - Type Unspecified
CTD400001483 / C00023Medicare PIN
CT001469857Medicaid