Provider Demographics
NPI:1023086592
Name:BUTTROSS, MELANIE J (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:BUTTROSS
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 1:4910 MASSACHUSETTS AVE NW
Mailing Address - Street 2:STE 21
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4360
Mailing Address - Country:US
Mailing Address - Phone:202-686-6700
Mailing Address - Fax:202-537-1442
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW
Practice Address - Street 2:STE 21
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4360
Practice Address - Country:US
Practice Address - Phone:202-686-6700
Practice Address - Fax:202-537-1442
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047865207W00000X
VA0101046588207W00000X
DCMD19025207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6375588Medicaid
DCB365OtherCAREFIRST BCBS
409071Medicare ID - Type Unspecified
VA6375588Medicaid