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General NPI Number Information
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NPI Number | 1912094475
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Entity Type | Individual
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Provider Name | CHARLES L. BUTTZ MD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 3322 N. BROAD STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19140
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Country | US
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Telephone | 215-707-4600
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Fax | 215-707-4034
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Provider Business Mailing Address
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Address Line | 2450 W HUNTING PARK AVE 3RD FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1302
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Country | US
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Telephone | 215-707-8561
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Fax | 215-707-3677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD-041932E
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License Number State | PA
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