MEDICARE: DR. RICHARD OTTO SUTTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	14847	KY

General Provider Information

NPI Number	:	1124175674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD OTTO SUTTON MD

Provider Business Mailing Address
First Line	:	8904 GARDEN GATE DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-1471
Country	:	US
Telephone Number	:	703-623-9159
Fax Number	:	703-602-2306

Provider Business Practice Location Address
First Line	:	1901 S BELL ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-4511
Country	:	US
Telephone Number	:	703-607-1598
Fax Number	:	703-602-2306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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