Provider Demographics
NPI:1366523102
Name:BUTERA, CHRISTINA L (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:BUTERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224D CORNWALL ST NW STE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:21475 RIDGETOP CIRCLE SUITE 300
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8580
Practice Address - Country:US
Practice Address - Phone:703-430-4400
Practice Address - Fax:703-430-4130
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236101207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1366523102Medicaid
VA0858550001Medicare NSC
VA137549OtherANTHEM BCBS/HEALTHKEEPERS
VA010074282Medicaid
VA137553OtherANTHEM BCBS/HEALTHKEEPERS
VA137558OtherANTHEM BCBC/HEALTHKEEPERS
VAG75151Medicare UPIN
VA010074258Medicaid
VA137557OtherANTHEM BCBS/HEALTHKEEPERS
VA004641N82Medicare ID - Type UnspecifiedTRAILBLAZERS CENTRAL VA
VA014993N63Medicare ID - Type UnspecifiedTRAILBLAZERS NVA, DEL, MD
VA0858550001Medicare NSC