Provider Demographics
NPI:1770610123
Name:BUTLER, KATHRYN L (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
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 1:110 FRANCIS STREET, SUITE 3A
Mailing Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-632-9922
Mailing Address - Fax:617-632-0886
Practice Address - Street 1:110 FRANCIS STREET, SUITE 3A
Practice Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-632-9922
Practice Address - Fax:617-632-0886
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-228438208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery