Provider Demographics
NPI:1700836384
Name:BUTKA, MATTHEW D (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:BUTKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LONGWATER CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1642
Mailing Address - Country:US
Mailing Address - Phone:781-659-1800
Mailing Address - Fax:781-659-7221
Practice Address - Street 1:99 LONGWATER CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1642
Practice Address - Country:US
Practice Address - Phone:781-659-1800
Practice Address - Fax:781-659-7221
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA209481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0201197Medicaid
MAA38042Medicare ID - Type Unspecified
H43814Medicare UPIN