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General NPI Number Information
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NPI Number | 1609805084
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Entity Type | Individual
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Provider Name | LEROY SUTHERLAND, MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 110 REHILL AVE
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City | SOMERVILLE
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State | NJ
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Zip | 08876-2519
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Country | US
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Telephone | 908-209-5247
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Fax |
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Provider Business Mailing Address
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Address Line | 285 DAVIDSON AVE STE 204
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City | SOMERSET
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State | NJ
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Zip | 08873-4153
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Country | US
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Telephone | 732-271-1400
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Fax | 732-271-3544
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 218334
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA09590900
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License Number State | NJ
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