Healthcare Provider Details

I. General information

NPI: 1730044355
Provider Name (Legal Business Name): AMANDA E BUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MEDSTAR BLVD STE 325
BEL AIR MD
21015-1817
US

IV. Provider business mailing address

9712 SILVER FARM CT
PERRY HALL MD
21128-9052
US

V. Phone/Fax

Practice location:
  • Phone: 410-877-8078
  • Fax:
Mailing address:
  • Phone: 443-425-8359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: