MEDICARE: MRS. SUSAN OLIVE DUNCAN-BUTLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2001-00861	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NC8802C	OTHER	NC	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	130U1	OTHER	NC	BCBS PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184621534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN OLIVE DUNCAN-BUTLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-7840
Fax Number	:	704-384-7830

Provider Business Practice Location Address
First Line	:	3614 PROVIDENCE RD S STE 101
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-6309
Country	:	US
Telephone Number	:	704-384-8460
Fax Number	:	704-384-8771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/25/2020

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