Individual
ANISH ATUL BUTALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 CIVIC CENTER BOULEVARD, TRC-2 WEST, PHILADELPHIA, PA 19104
(267) 438-7203
Mailing address
3400 CIVIC CENTER BOULEVARD, TRC-2 WEST, PHILADELPHIA, PA 19104
(267) 438-7203
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT210439
PA
2085R0203X
Therapeutic Radiology Physician
Primary
MD472450
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/15/2015
Last updated
08/27/2021
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