Provider Demographics
NPI:1487651980
Name:BUTLER, ANNELORE FONTANE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNELORE
Middle Name:FONTANE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNELORE
Other - Middle Name:FONTANE
Other - Last Name:ENYART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:533 ELIZABETH PL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2408
Mailing Address - Country:US
Mailing Address - Phone:757-397-7283
Mailing Address - Fax:
Practice Address - Street 1:2100 LYNNHAVEN PKWY
Practice Address - Street 2:SIUTE 201
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1492
Practice Address - Country:US
Practice Address - Phone:757-953-6708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057817208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics