Provider Demographics
NPI:1487668000
Name:BUTLER, CYNTHIA P (DO)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:P
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 B HWY 135
Mailing Address - Street 2:
Mailing Address - City:MAYODAN
Mailing Address - State:NC
Mailing Address - Zip Code:27027
Mailing Address - Country:US
Mailing Address - Phone:336-573-9228
Mailing Address - Fax:336-573-2977
Practice Address - Street 1:6701 B HWY 135
Practice Address - Street 2:
Practice Address - City:MAYODAN
Practice Address - State:NC
Practice Address - Zip Code:27027
Practice Address - Country:US
Practice Address - Phone:336-573-9228
Practice Address - Fax:336-573-2977
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920451Medicaid
F46922Medicare UPIN
NC8920451Medicaid