Provider Demographics
NPI:1013997634
Name:BUTLER, KATHLEEN G (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:G
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 OLD BRANCH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1608
Mailing Address - Country:US
Mailing Address - Phone:301-856-6718
Mailing Address - Fax:301-856-6722
Practice Address - Street 1:8926 WOODYARD RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4220
Practice Address - Country:US
Practice Address - Phone:301-856-3670
Practice Address - Fax:301-868-0129
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD29846174400000X
VA0101236437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0100122465Medicaid
VAP00340125Medicare PIN
MDP00352363Medicare PIN
DC015658R04Medicare PIN
DCP00174642Medicare PIN
VA00X011N01Medicare PIN
MD221LJ994Medicare PIN