MEDICARE: ERNEST A SUTCLIFFE M.D.

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	207W00000X	Ophthalmology Physician	47551	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	SUJ02245	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1831116748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST A SUTCLIFFE M.D.

Provider Business Mailing Address
First Line	:	65 WALNUT ST
Second Line	:	SUITE 330
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-2118
Country	:	US
Telephone Number	:	781-237-1580
Fax Number	:	781-237-6382

Provider Business Practice Location Address
First Line	:	65 WALNUT ST
Second Line	:	SUITE 330
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-2118
Country	:	US
Telephone Number	:	781-237-1580
Fax Number	:	781-237-6382

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/08/2007

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