Healthcare Provider Details

I. General information

NPI: 1114445368
Provider Name (Legal Business Name): ZACHARY D BUTT CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S CHURCH ST
MIDDLETOWN MD
21769-8043
US

IV. Provider business mailing address

PO BOX 20
MIDDLETOWN MD
21769-0020
US

V. Phone/Fax

Practice location:
  • Phone: 301-371-9000
  • Fax: 301-371-8905
Mailing address:
  • Phone: 301-371-9000
  • Fax: 301-371-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR206345
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: