Healthcare Provider Details

I. General information

NPI: 1922464981
Provider Name (Legal Business Name): AUGUSTUS M SUTERA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD MICU, 3RD FLOOR, E TOWER, RM 3E46
NEWARK DE
19718-2200
US

IV. Provider business mailing address

214 STANTON RD
HAVERTOWN PA
19083-2903
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax:
Mailing address:
  • Phone: 267-496-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC5-0001044
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: