MEDICARE: JEWELLE R SUTHERLAND 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	207R00000X	Internal Medicine Physician	25MA06384400	NJ
2	207RP1001X	Pulmonary Disease Physician	25MA06384400	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CB7268	OTHER	NJ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2127243000	OTHER	NJ	AMERIHEALTH HMO
3	001443342	OTHER	NJ	IND BC PPO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861482440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEWELLE R SUTHERLAND MD

Provider Business Mailing Address
First Line	:	301 LIPPINCOTT DR STE 410
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4197
Country	:	US
Telephone Number	:	856-355-0340
Fax Number	:	856-355-0330

Provider Business Practice Location Address
First Line	:	141 ROUTE 70 E STE B
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-1855
Country	:	US
Telephone Number	:	856-596-9057
Fax Number	:	856-596-0837

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	10/22/2020

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Directions to “ JEWELLE R SUTHERLAND MD” Practice Location

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