Healthcare Provider Details

I. General information

NPI: 1659799286
Provider Name (Legal Business Name): MARK EDWARD SUTHERLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST ROOM N3E09
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

22 S GREENE ST ROOM N3E09
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0090063
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0090063
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: