Healthcare Provider Details

I. General information

NPI: 1215909833
Provider Name (Legal Business Name): NORMAN C SUDDUTH MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S CONGRESS AVE JFK MEDICAL CENTER
ATLANTIS FL
33462
US

IV. Provider business mailing address

PO BOX 63069
CHARLESTON SC
29406
US

V. Phone/Fax

Practice location:
  • Phone: 561-548-3639
  • Fax: 561-548-3702
Mailing address:
  • Phone: 305-229-4311
  • Fax: 305-229-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: NORMAN C SUDDUTH
Title or Position: PRESIDENT
Credential: MD
Phone: 561-548-3639