Provider Demographics
NPI:1629049606
Name:BUTLER, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 156
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-947-7924
Mailing Address - Fax:215-947-0187
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 156
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-947-7924
Practice Address - Fax:215-947-0187
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD059321L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110138026OtherRAILROAD MEDICARE
PA1672562Medicaid
PAG30396Medicare UPIN
PA882569EQ2Medicare PIN
PA882569Medicare PIN