Individual
MRS. SUSAN OLIVE DUNCAN-BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3614 PROVIDENCE RD S STE 101, WAXHAW, NC 28173-6309
(704) 384-8460
(704) 384-8771
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2001-00861
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184621534
—
NC
01
—
130U1
BCBS PROVIDER NUMBER
NC
01
—
NC8802C
MEDICARE
NC
Enumeration date
06/30/2005
Last updated
10/25/2020
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