Healthcare Provider Details

I. General information

NPI: 1609906619
Provider Name (Legal Business Name): SANAA A BUTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MEDICAL PARK DR FIRST FLOOR
MARION VA
24354-1100
US

IV. Provider business mailing address

1 CORPORATE RD SUITE 106
ENFIELD CT
06082-6402
US

V. Phone/Fax

Practice location:
  • Phone: 276-378-1341
  • Fax: 276-378-1345
Mailing address:
  • Phone: 888-789-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101240709
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101240709
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: