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NPI Code Detail

MEDICARE: EMMARY SAMEL BUTLER MD

MEDICARE: EMMARY SAMEL BUTLER MD
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
1207V00000XObstetrics & Gynecology PhysicianMD492056CPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11102268253OTHERINANTHEM PTAN

General Provider Information

NPI Number : 1275809311
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMARY SAMEL BUTLER MD
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-4903
Country : US
Telephone Number : 570-808-7916
Fax Number : 570-808-6006
Provider Business Practice Location Address
First Line : 1000 E MOUNTAIN DR
Second Line :
City : WILKES BARRE
State : PA
Zip : 18711-0001
Country : US
Telephone Number : 570-808-7916
Fax Number : 570-808-6006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2012
Last Update Date : 12/22/2025

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Directions to “ EMMARY SAMEL BUTLER MD” Practice Location

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