MEDICARE: JENNIFER LYN SUTHERLAND M.D., M.P.H

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	232049	MA
2	207Q00000X	Family Medicine Physician	051698	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063621829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYN SUTHERLAND M.D., M.P.H

Provider Business Mailing Address
First Line	:	28 CRESCENT ST
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-3654
Country	:	US
Telephone Number	:	860-358-6000
Fax Number	:	860-358-8661

Provider Business Practice Location Address
First Line	:	250 FLAT ROCK PLACE
Second Line	:	PHYS OFF 1
City	:	WESTBROOK
State	:	CT
Zip	:	06498-3585
Country	:	US
Telephone Number	:	860-358-3640
Fax Number	:	860-358-8656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	05/07/2024

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Directions to “ JENNIFER LYN SUTHERLAND M.D., M.P.H” Practice Location

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