Provider Demographics
NPI:1487647301
Name:BUTTLAR, CONSTANCE A (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:A
Last Name:BUTTLAR
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 1:42 LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-6008
Mailing Address - Country:US
Mailing Address - Phone:603-886-5865
Mailing Address - Fax:
Practice Address - Street 1:154 BROAD ST
Practice Address - Street 2:SUITE 1538
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3239
Practice Address - Country:US
Practice Address - Phone:603-889-4431
Practice Address - Fax:603-889-1572
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7941207ZP0102X
MA54077207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002601Medicaid
007941OtherTUFTS
NV220013062OtherRAILROAD MEDICARE
783906OtherMVP INS
NH0107574Y0NH01OtherBC/BS
6384OtherCIGNA/HEALTHSOURCE
NHE11757Medicare UPIN
783906OtherMVP INS