Provider Demographics
NPI:1902975089
Name:ATUL BUTALA PHYSICIAN PC
Entity Type:Organization
Organization Name:ATUL BUTALA PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:BUTALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP
Authorized Official - Phone:315-798-9300
Mailing Address - Street 1:807 NEWELL STREET
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502
Mailing Address - Country:US
Mailing Address - Phone:315-798-9300
Mailing Address - Fax:315-793-8320
Practice Address - Street 1:807 NEWELL STREET
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-798-9300
Practice Address - Fax:315-793-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00997719Medicaid
55641AMedicare ID - Type Unspecified