MEDICARE: DR. ANNELORE FONTANE 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	0101057817	VA

General Provider Information

NPI Number	:	1487651980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNELORE FONTANE BUTLER M.D.

Provider Business Mailing Address
First Line	:	533 ELIZABETH PL
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2408
Country	:	US
Telephone Number	:	757-397-7283
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 LYNNHAVEN PKWY
Second Line	:	SIUTE 201
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1492
Country	:	US
Telephone Number	:	757-953-6708
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	06/16/2010

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