Healthcare Provider Details

I. General information

NPI: 1295182525
Provider Name (Legal Business Name): EMILY SUTHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 MAIN ST STE 106
WINCHESTER MA
01890-4300
US

IV. Provider business mailing address

955 MAIN ST STE 106
WINCHESTER MA
01890-4300
US

V. Phone/Fax

Practice location:
  • Phone: 781-729-4262
  • Fax: 781-729-0692
Mailing address:
  • Phone: 401-444-4471
  • Fax: 401-444-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP03602
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: