Healthcare Provider Details

I. General information

NPI: 1275153074
Provider Name (Legal Business Name): BENJAMIN THOMAS BUTERBAUGH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WH SMITH BLVD
GREENVILLE NC
27834-3763
US

IV. Provider business mailing address

810 WH SMITH BLVD
GREENVILLE NC
27834-3763
US

V. Phone/Fax

Practice location:
  • Phone: 252-757-2663
  • Fax:
Mailing address:
  • Phone: 252-757-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number2024-00943
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: