Provider Demographics
NPI:1346304847
Name:BUTT, WASEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:WASEEM
Middle Name:
Last Name:BUTT
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 1:3 PENNS TRL
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1812
Mailing Address - Country:US
Mailing Address - Phone:609-528-8884
Mailing Address - Fax:
Practice Address - Street 1:3 PENNS TRL
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1812
Practice Address - Country:US
Practice Address - Phone:609-528-8884
Practice Address - Fax:609-528-8886
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0013720207RG0100X
PAMD446159207R00000X, 207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2738658Medicaid
PA1027577740001Medicaid
PA255930Medicare PIN
PA1027577740001Medicaid
OH2738658Medicaid
OH4204201Medicare PIN