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NPI Code Detail

MEDICARE: DR. MICHAEL JOHN SUTULA M.D.

MEDICARE: DR. MICHAEL JOHN SUTULA M.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianD26762MD

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IG03OTHERMDMEDICARE GROUP NUMBER

General Provider Information

NPI Number : 1639260805
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL JOHN SUTULA M.D.
Provider Business Mailing Address
First Line : 3001 SOUTH HANOVER STREET
Second Line :
City : BALTIMORE
State : MD
Zip : 21225-2133
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3001 SOUTH HANOVER STREET
Second Line :
City : BALTIMORE
State : MD
Zip : 21225-2133
Country : US
Telephone Number : 410-350-3362
Fax Number : 301-604-7523
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 10/26/2007

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