Healthcare Provider Details

I. General information

NPI: 1700902046
Provider Name (Legal Business Name): JOHN PATRICK SUTTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH GLEBE RD SUITE 104 PHOENIX HOUSE MID ATLANTIC
ARLINGTON VA
22203
US

IV. Provider business mailing address

200 NORTH GLEBE RD SUITE 104 PHOENIX HOUSE MID ATLANTIC
ARLINGTON VA
22203
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-0703
  • Fax: 703-243-0975
Mailing address:
  • Phone: 703-841-0703
  • Fax: 703-243-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD036177
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101263708
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: