Active NPI
Danielle Marie Butchko, PA-C
- Physician Assistant
- Mount Laurel, NJ
National Provider Identifier
1316216054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00274700
- Practice address
- 15000 Midlantic Dr Ste 102
Mount Laurel, NJ 08054-1573 - Phone
- (856) 255-5479
- NPI assigned
- Dec 27, 2011
- Last updated
- Apr 4, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 25MP00274700 | NJ | Primary |
Addresses
Primary practice location
15000 Midlantic Dr Ste 102
Mount Laurel, NJ 08054-1573
Mailing address
20 Lavister Dr
Mount Laurel, NJ 08054-2642
Phone (609) 694-7298
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491264000000",
"number": "1316216054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 LAVISTER DR",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "080542642",
"telephone_number": "609-694-7298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15000 MIDLANTIC DR STE 102",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "080541573",
"telephone_number": "856-255-5479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTCHKO",
"first_name": "DANIELLE",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-27",
"last_updated": "2017-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00274700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Laurel, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.