Healthcare Provider Details

I. General information

NPI: 1780855148
Provider Name (Legal Business Name): ANNE KATHLEEN SUTHERLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST UNIVERSITY HOSPITAL, ROOM I-354
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

150 BERGEN ST UNIVERSITY HOSPITAL, ROOM I-354
NEWARK NJ
07103-2496
US

V. Phone/Fax

Practice location:
  • Phone: 973-973-6111
  • Fax: 973-972-0128
Mailing address:
  • Phone: 973-973-6111
  • Fax: 973-972-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number230068
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number230068
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA09424400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA09424400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: