Provider Demographics
NPI:1528060092
Name:MAHAN BUTTARO, TERRY E (NP)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:E
Last Name:MAHAN BUTTARO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SOUTHER LN
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01952-1613
Mailing Address - Country:US
Mailing Address - Phone:978-465-1007
Mailing Address - Fax:978-388-4035
Practice Address - Street 1:24 MORRILL PL
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3530
Practice Address - Country:US
Practice Address - Phone:978-388-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA96481363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMANP0617Medicare ID - Type Unspecified
MAS20786Medicare UPIN