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General NPI Number Information
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NPI Number | 1528282241
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Entity Type | Organization
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Legal Business Name | JOSHUA P SUTHERLAND JR PC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 20886 RIVERSIDE DRIVE
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City | GRUNDY
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State | VA
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Zip | 24614
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Country | US
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Telephone | 276-935-7515
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Fax | 276-935-4351
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Provider Business Mailing Address
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Address Line | PO BOX 1030 20886 RIVERSIDE DRIVE
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City | GRUNDY
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State | VA
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Zip | 24614-1030
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Country | US
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Telephone | 276-935-7515
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Fax | 276-935-4351
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSHUA P SUTHERLAND JR.
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Credential | DO
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Telephone | 276-935-7515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102035890
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License Number State | VA
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