Provider Demographics
NPI:1417443169
Name:BUTLER, BRENDAN (NP)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HOLLING PL UNIT 302
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5061
Mailing Address - Country:US
Mailing Address - Phone:240-498-7777
Mailing Address - Fax:
Practice Address - Street 1:310 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6435
Practice Address - Country:US
Practice Address - Phone:443-485-6213
Practice Address - Fax:443-485-6226
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR232767363L00000X, 363LF0000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily