Provider Demographics
NPI:1982676060
Name:BUTT, KHALID RASHID (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:RASHID
Last Name:BUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13733-1221
Mailing Address - Country:US
Mailing Address - Phone:607-967-2071
Mailing Address - Fax:607-967-2347
Practice Address - Street 1:12 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13733-1221
Practice Address - Country:US
Practice Address - Phone:607-967-2071
Practice Address - Fax:607-967-2347
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02586501Medicaid
NYI14270Medicare UPIN
NY02586501Medicaid