Provider Demographics
NPI:1770774242
Name:RUSSELL B. BUTLER, MD, PC
Entity type:Organization
Organization Name:RUSSELL B. BUTLER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-369-7812
Mailing Address - Street 1:131 ORNAC
Mailing Address - Street 2:JCB 730
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4181
Mailing Address - Country:US
Mailing Address - Phone:978-369-7812
Mailing Address - Fax:978-369-3353
Practice Address - Street 1:131 ORNAC
Practice Address - Street 2:JCB 730
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4181
Practice Address - Country:US
Practice Address - Phone:978-369-7812
Practice Address - Fax:978-369-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA381982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty