Healthcare Provider Details

I. General information

NPI: 1073515045
Provider Name (Legal Business Name): CHARLES BUTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 CENTENNIAL BLVD SUITE 7
VOORHEES NJ
08043-9544
US

IV. Provider business mailing address

502 CENTENNIAL BLVD SUITE 7
VOORHEES NJ
08043-9544
US

V. Phone/Fax

Practice location:
  • Phone: 856-596-7440
  • Fax: 856-596-6723
Mailing address:
  • Phone: 856-596-7440
  • Fax: 856-596-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA02489000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: