Provider Demographics
NPI:1184621534
Name:DUNCAN-BUTLER, SUSAN OLIVE (MD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:OLIVE
Last Name:DUNCAN-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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7840
Mailing Address - Fax:704-384-7830
Practice Address - Street 1:3614 PROVIDENCE RD S STE 101
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6309
Practice Address - Country:US
Practice Address - Phone:704-384-8460
Practice Address - Fax:704-384-8771
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001-00861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC8802COtherMEDICARE
NC130U1OtherBCBS PROVIDER NUMBER
NC1184621534Medicaid
NCH58097Medicare UPIN
NCNC8802COtherMEDICARE
NCH58097Medicare UPIN