Provider Demographics
NPI:1982683173
Name:BUTLER, ABIDA B (MD)
Entity Type:Individual
Prefix:
First Name:ABIDA
Middle Name:B
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-444-0650
Mailing Address - Fax:631-638-4170
Practice Address - Street 1:HSC
Practice Address - Street 2:T16 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8160
Practice Address - Country:US
Practice Address - Phone:631-444-8478
Practice Address - Fax:631-444-7546
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2017-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA11514R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124691Medicaid
MSP00803002OtherRRMCARE THRU HCCN
LAG6438OtherBLUECROSS BLUESHIELD
LA1669962Medicaid
LAG6438OtherBLUECROSS BLUESHIELD
G17718Medicare UPIN
LA5A041CM53Medicare PIN