Healthcare Provider Details

I. General information

NPI: 1366795023
Provider Name (Legal Business Name): MATTHEW P. BUTLER, D.P.M. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 CENTRE STREET, SUITE # 5980 BRIGHAM AND WOMEN'S FAULKNER HOSPITAL
BOSTON MA
02130
US

IV. Provider business mailing address

1153 CENTRE STREET, SUITE # 5980 BRIGHAM AND WOMEN'S FAULKNER HOSPITAL
BOSTON MA
02130
US

V. Phone/Fax

Practice location:
  • Phone: 617-983-1900
  • Fax:
Mailing address:
  • Phone: 617-983-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2037
License Number StateMA

VIII. Authorized Official

Name: MATTHEW P. BUTLER
Title or Position: PHYSICIAN
Credential: D.P.M.
Phone: 617-983-1900