Provider Demographics
NPI:1609906619
Name:BUTT, SANAA A (MD)
Entity Type:Individual
Prefix:
First Name:SANAA
Middle Name:A
Last Name:BUTT
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 1:1 CORPORATE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-6402
Mailing Address - Country:US
Mailing Address - Phone:888-789-3020
Mailing Address - Fax:
Practice Address - Street 1:245 MEDICAL PARK DR
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-1100
Practice Address - Country:US
Practice Address - Phone:276-378-1341
Practice Address - Fax:276-378-1345
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240709208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1609906619Medicaid
TNQ012798Medicaid
TNQ012798Medicaid
VA1609906619Medicaid
VA013184V16Medicare PIN
P00382724Medicare PIN