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General NPI Number Information
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NPI Number | 1639194764
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Entity Type | Individual
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Provider Name | CARISA MARICE SUTHERLAND MD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 231 S SHARON AMITY RD
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City | CHARLOTTE
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State | NC
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Zip | 28211-2803
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Country | US
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Telephone | 704-304-6400
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Fax | 704-442-7021
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Provider Business Mailing Address
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Address Line | PO BOX 602148
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City | CHARLOTTE
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State | NC
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Zip | 28260-2148
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Country | US
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Telephone | 704-304-6400
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Fax | 704-442-7021
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 2007-00120
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 2007-00120
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2007-00120
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License Number State | NC
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