Provider Demographics
NPI:1891716197
Name:BUTCHER, JEFFREY LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LOUIS
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 1:1010 W CHESTER PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3442
Mailing Address - Country:US
Mailing Address - Phone:610-446-7882
Mailing Address - Fax:610-446-3316
Practice Address - Street 1:1010 W CHESTER PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3442
Practice Address - Country:US
Practice Address - Phone:610-446-7882
Practice Address - Fax:610-446-3316
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428686208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017250410001Medicaid
PA103611VX8Medicare PIN
PA1017250410001Medicaid