Basic Information
| Provider Information | |||||||||
| NPI: | 1205931144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTT | ||||||||
| FirstName: | AMIR | ||||||||
| MiddleName: | SHAHZAD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37174 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714235699 | ||||||||
| FaxNumber: | 5714235698 | ||||||||
| Practice Location | |||||||||
| Address1: | 44055 RIVERSIDE PKWY STE 226 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201765177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038586202 | ||||||||
| FaxNumber: | 7038588160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 2010-00171 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207R00000X | 0101254410 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 0101254410 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1205931144 | 05 | VA | MEDICAID | 158MF | 01 | NC | BCBSNC | OTHER | 5914886 | 05 | NC | MEDICAID |