Provider Demographics
NPI:1093807158
Name:SUTHERLAND, DALE F (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:F
Last Name:SUTHERLAND
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 1:211 EXECUTIVE DR STE 11
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3358
Mailing Address - Country:US
Mailing Address - Phone:302-451-6913
Mailing Address - Fax:302-368-7756
Practice Address - Street 1:12100 BLACK SWAN DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4988
Practice Address - Country:US
Practice Address - Phone:302-644-3311
Practice Address - Fax:302-644-3300
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008250207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09909511Medicaid
1184681488OtherEMPLOYER - ORTHOPAEDIC ASSOC OF SO DE PA