Provider Demographics
NPI:1306824289
Name:SUTTON, CHRISTOPHER DAVID (MD)
Entity Type:Individual
Prefix:PROF
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:SUTTON
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 1:4035 ELECTRIC RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8433
Mailing Address - Country:US
Mailing Address - Phone:540-772-8670
Mailing Address - Fax:540-772-7901
Practice Address - Street 1:4035 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8433
Practice Address - Country:US
Practice Address - Phone:540-772-8670
Practice Address - Fax:540-772-7901
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13354207Q00000X
VA0101247409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN
VAGC1100Medicare PIN