Provider Demographics
NPI:1023015369
Name:SUTTER, FREDERICK THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:THOMAS
Last Name:SUTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 DEFENSE HWY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7004
Mailing Address - Country:US
Mailing Address - Phone:410-224-4446
Mailing Address - Fax:
Practice Address - Street 1:171 DEFENSE HWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7004
Practice Address - Country:US
Practice Address - Phone:410-224-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2007-07-09
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
MDD0038446208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7577Medicare ID - Type UnspecifiedMEDICARE ID #
MDC34289Medicare UPIN