MEDICARE: MR. SIDNEY MICHAEL SUTTON SR. MD

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	29045	NC

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	:	1811978158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIDNEY MICHAEL SUTTON SR. MD

Provider Business Mailing Address
First Line	:	1141 N ROAD ST STE G
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3354
Country	:	US
Telephone Number	:	252-337-9120
Fax Number	:	855-330-7320

Provider Business Practice Location Address
First Line	:	1141 N ROAD ST STE G
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3354
Country	:	US
Telephone Number	:	252-337-9120
Fax Number	:	855-330-7320

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	12/06/2023

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