Individual
KENNETH BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
110 S PACA ST, SIXTH FLOOR, SUITE 200, BALTIMORE, MD 21201-1642
(410) 328-8025
(410) 328-8028
Mailing address
PO BOX 73276, BALTIMORE, MD 21273-0001
(301) 631-8103
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
H0046145
MD
207P00000X
Emergency Medicine Physician
Primary
H46145
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122731900
—
MD
01
—
H254
MEDICARE GROUP NUMBER
MD
Enumeration date
03/28/2007
Last updated
09/22/2010
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