Provider Demographics
NPI:1689659146
Name:BUTTOLPH, MARIA LYNN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LYNN
Last Name:BUTTOLPH
Suffix:
Gender:F
Credentials:MD PHD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:185 CAMBRIDGE ST
Practice Address - Street 2:SIMCHES RESEARCH CENTER, OCD UNIT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-6766
Practice Address - Fax:617-643-3080
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA583082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA717922OtherTUFTS HEALTH PLAN
MA3118894Medicaid
MAJ06862OtherBCBS MA
MA717922OtherTUFTS HEALTH PLAN
MA3118894Medicaid