Provider Demographics
NPI:1497748644
Name:BUTLER, CRAIG A (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:BUTLER
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:PO BOX 8500-1672
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-1672
Mailing Address - Country:US
Mailing Address - Phone:215-612-5290
Mailing Address - Fax:215-612-4942
Practice Address - Street 1:380 OXFORD VALLEY RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8304
Practice Address - Country:US
Practice Address - Phone:215-409-9300
Practice Address - Fax:215-409-9368
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448833207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257525600Medicaid
FL257525600Medicaid
42981ZMedicare ID - Type Unspecified