Healthcare Provider Details

I. General information

NPI: 1780940114
Provider Name (Legal Business Name): MICHELLE SUTHERLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE BRETT

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW DEPT OF OBSTETRICS AND GYNECOLOGY
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

1100 NEW JERSEY AVE SE
WASHINGTON DC
20003-3302
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-8035
  • Fax: 202-877-5435
Mailing address:
  • Phone: 202-715-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD047696
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: