Healthcare Provider Details

I. General information

NPI: 1053598565
Provider Name (Legal Business Name): SUTHERLAND NEUROLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 W CENTER ST # 401
MARION OH
43302-3742
US

IV. Provider business mailing address

165 W CENTER ST # 401
MARION OH
43302-3742
US

V. Phone/Fax

Practice location:
  • Phone: 740-382-4121
  • Fax:
Mailing address:
  • Phone: 740-382-4121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35-053397
License Number StateOH

VIII. Authorized Official

Name: STEPHEN R SUTHERLAND
Title or Position: OWNER
Credential: M.D.
Phone: 740-382-4121