William R Butler, M.D.
Individual provider Active NPI Surgery Physician · Bridgeport, CT
NPI 1124087226 · NPPES record last updated Sep 9, 2015
Key facts
- NPI
- 1124087226
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 033726 (CT)
- Practice address
- 226 Mill Hill Ave
3Rd Floor
Bridgeport, CT 06610-2811 - Phone
- (203) 384-3873
- Fax
- (203) 384-3829
- NPI assigned
- Mar 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040412001439 | CT | Practitioner - General Surgery | 8921092024 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033726 | CT | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Medical Group, Inc. | Surgery | Current |
Accepting new patients |
Locations
226 Mill Hill Ave
Ste 3
Bridgeport, CT 06610
Phone (203) 384-3394
267 Grant St
Bridgeport, CT 06610
Phone (203) 384-3170
95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 033726 | CT | Yes |
Addresses
Primary practice location
226 Mill Hill Ave
3Rd Floor
Bridgeport, CT 06610-2811
Mailing address
PO Box 5246
Bridgeport, CT 06610-0246
Phone (203) 384-3873
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001337262 | Medicaid | CT |
Other providers in Bridgeport, CT
- Lisa L Burns
- Mary Ann Burr
- Jasmine Vanessa Bustillo
- Christine G Butler
- Sabrina Butler
- Eleanor Marie Cabrera Aguirre
- John Cacace
- Paige Cackovic
- Alex Scott Cadan
- Rachel Cadan
All providers in Bridgeport, CT · Surgery Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.