Individual ProviderMitul ButalaFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709(703) 391-3600(571) 423-5699PECOS EnrollmentBased on the most recent information from CMS, provider Mitul Butala is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1881986164Provider TypeIndividualFull NameButala, MitulCredentialMDGenderMaleSole ProprietorNoEnumeration Date5/5/2011Last Updated8/19/2021Contact InformationPractice LocationPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709Phone(703) 391-3600Fax(703) 391-3414Mailing LocationMailing AddressPO Box 37174, Baltimore, MD 21297-3174Phone(571) 423-5699Fax(571) 423-5698Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense0101272781VirginiaCode208M00000XDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicenseMD452723Pennsylvania