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NPI Code Detail

MEDICARE: DR. ASHVIN BUTALA MD

MEDICARE: DR. ASHVIN BUTALA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0200XCritical Care Medicine (Internal Medicine) Physician183040NY

General Provider Information

NPI Number : 1144223512
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ASHVIN BUTALA MD
Provider Business Mailing Address
First Line : 23 SHEPHERD LN
Second Line :
City : ROSLYN HEIGHTS
State : NY
Zip : 11577-2506
Country : US
Telephone Number : 516-626-3732
Fax Number :
Provider Business Practice Location Address
First Line : 170 BUFFALO AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11213-2421
Country : US
Telephone Number : 718-221-3260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 05/04/2017

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