Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT204393 | PA |
Y | 2080P0203X | Pediatric Critical Care Doctor | MT204393 | PA |
NPI | 1033556618 |
---|---|
Provider Name | Dr. Andrew David Butler |
First Address | Philadelphia, PA 19134-1043 |
Second Address | Philadelphia, PA 19134-1011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2013 |
Last Update Date | 18/03/2020 |