Provider Demographics
NPI:1831116805
Name:BUTCHER, CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N STATE OF FRANKLIN RD
Mailing Address - Street 2:ROOM 2746
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6035
Mailing Address - Country:US
Mailing Address - Phone:423-431-2727
Mailing Address - Fax:423-431-6715
Practice Address - Street 1:150 DUNCAN RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:WV
Practice Address - Zip Code:24924-9037
Practice Address - Country:US
Practice Address - Phone:304-799-7400
Practice Address - Fax:304-799-1074
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21677207R00000X
TN53540207R00000X, 207RC0200X
NC2014-02347207RP1001X
VA0101240820207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831116805Medicaid
VAP01092488OtherRAILROAD MEDICARE
VA1831116805Medicaid
TNQ017835Medicaid
VA010378796Medicaid
VA010378931Medicaid
NC19AMBOtherBCBS NC
VA010378915Medicaid
TNP01662096OtherRAILROAD MEDICARE
VA010378931Medicaid
012042C21Medicare PIN
TNQ017835Medicaid
VA1831116805Medicaid
VAVV7091AMedicare PIN
TN103I817215Medicare PIN