Healthcare Provider Details

I. General information

NPI: 1619065398
Provider Name (Legal Business Name): MARC J BUTCHER D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 N BROAD STREET EXT STE 204
GROVE CITY PA
16127-4604
US

IV. Provider business mailing address

647 N BROAD STREET EXT STE 204
GROVE CITY PA
16127-4604
US

V. Phone/Fax

Practice location:
  • Phone: 724-458-6245
  • Fax: 724-458-6244
Mailing address:
  • Phone: 724-458-6245
  • Fax: 724-458-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN006219
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC007054
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number828
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN006219
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberN006219
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number828
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number828
License Number StateMN
# 8
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006219
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number828
License Number StateMN
# 10
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN006219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: