Healthcare Provider Details

I. General information

NPI: 1710247705
Provider Name (Legal Business Name): PATRICK BUTSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 GORHAM RD STE 303
SOUTH PORTLAND ME
04106-2461
US

IV. Provider business mailing address

225 GORHAM RD STE 303
SOUTH PORTLAND ME
04106-2461
US

V. Phone/Fax

Practice location:
  • Phone: 207-535-1880
  • Fax: 207-535-1876
Mailing address:
  • Phone: 207-535-1880
  • Fax: 207-535-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD27629
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: