MEDICARE: DR. DARSHANI ASHVIN BUTALA 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
1	207R00000X	Internal Medicine Physician	206282	NY

General Provider Information

NPI Number	:	1831192202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARSHANI ASHVIN BUTALA MD

Provider Business Mailing Address
First Line	:	23 SHEPHERD LN
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2506
Country	:	US
Telephone Number	:	516-626-3732
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3986
Country	:	US
Telephone Number	:	718-381-8520
Fax Number	:	718-381-8521

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/26/2010

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