Provider Demographics
NPI:1265659684
Name:SUTHERLAND, JULIE P
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:P
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1121
Mailing Address - Country:US
Mailing Address - Phone:303-881-3391
Mailing Address - Fax:
Practice Address - Street 1:55 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1121
Practice Address - Country:US
Practice Address - Phone:303-881-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38745207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
015928OtherKAISER-COMMERCIAL NUMBER
CO77905041Medicaid
CO77905041Medicaid
COCO306887Medicare PIN
COH18756Medicare UPIN