MEDICARE: JOHN J 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	207Q00000X	Family Medicine Physician	MD054007L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	529218	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1164490025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J SUTTON MD

Provider Business Mailing Address
First Line	:	2 W CRESCENT PARK
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-2111
Country	:	US
Telephone Number	:	814-723-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 W SAINT CLAIR ST RM 2A
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-2188
Country	:	US
Telephone Number	:	814-723-1212
Fax Number	:

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	08/12/2020

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