Healthcare Provider Details

I. General information

NPI: 1699415455
Provider Name (Legal Business Name): CALEY BUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

4914 FOX CHASE RD
GREENSBORO NC
27410-2550
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-6890
  • Fax:
Mailing address:
  • Phone: 512-554-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD600005200
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD600005200
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: