Provider Demographics
NPI:1881617520
Name:SMALL, CATHERINE BUTKUS (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:BUTKUS
Last Name:SMALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 WOODS ROAD-NYMC
Mailing Address - Street 2:DEPT OF MEDICINE-
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-493-8865
Mailing Address - Fax:914-594-4434
Practice Address - Street 1:100 WOODS ROAD-NYMC
Practice Address - Street 2:DEPT OF MEDICINE-
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-8865
Practice Address - Fax:914-594-4434
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY136538207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00835667Medicaid
NY17D863OtherEMPIRE BCBS
NY007902OtherCONNECTICARE
NY136538OtherHIP
NYP967452OtherOXFORD
NYSC6538OtherATLANTIS
NY0006077OtherGHI PPO
NY2234414OtherAETNA HMO
NY440002970OtherRAILROAD MEDICARE
NY4655736OtherAETNA PPO
NY5C6268OtherHEALTHNET
NY17D863OtherEMPIRE BCBS