Provider Demographics
NPI:1568445526
Name:BUTLER, AMY E (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:BUTLER
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 1:199 HOSPITAL DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 HOSPITAL DR
Practice Address - Street 2:SUITE 7
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2454
Practice Address - Country:US
Practice Address - Phone:276-236-5181
Practice Address - Fax:276-236-3297
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-232843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005642493Medicaid
VA010027152Medicaid
VA0005642485Medicaid
VA005642493Medicaid
VA000343C86Medicare PIN
H64705Medicare UPIN
VA0005642485Medicaid
003359C63Medicare PIN