Provider Demographics
NPI:1447211610
Name:BUTLER, JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 STONER AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5698
Mailing Address - Country:US
Mailing Address - Phone:410-848-6800
Mailing Address - Fax:410-857-4227
Practice Address - Street 1:295 STONER AVE
Practice Address - Street 2:STE 105
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5698
Practice Address - Country:US
Practice Address - Phone:410-848-6800
Practice Address - Fax:410-857-4227
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00342213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000128875Medicaid
PA0015378422116533OtherBC PA
MD200224590OtherCOMMERCIAL
MD30537007OtherBCBS OF MD
MD54715344507OtherUHC GROUP
MD600668000Medicaid
DCJ2390001OtherBC DC/METRO
PA074320116533R61Medicare PIN
MDT29184Medicare UPIN
MD4956240002Medicare NSC
MD103ZMedicare PIN
DCJ2390001OtherBC DC/METRO
MD600668000Medicaid