Healthcare Provider Details

I. General information

NPI: 1154385078
Provider Name (Legal Business Name): MATTHEW P BUTLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAPLE STREET SUITE 405
MARLBOROUGH MA
01752
US

IV. Provider business mailing address

1153 CENTRE ST SUITE 5980
BOSTON MA
02130-3446
US

V. Phone/Fax

Practice location:
  • Phone: 617-480-2541
  • 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:
Title or Position:
Credential:
Phone: