Provider Demographics
NPI:1336132802
Name:SUTHERLAND, JOSHUA PRICE JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:PRICE
Last Name:SUTHERLAND
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-1030
Mailing Address - Country:US
Mailing Address - Phone:276-935-7515
Mailing Address - Fax:276-935-4351
Practice Address - Street 1:RT 460 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614
Practice Address - Country:US
Practice Address - Phone:276-935-7515
Practice Address - Fax:276-935-4351
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA35890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005651689Medicaid
VA014001OtherANTHEM BLUE CROSS
010000113Medicare ID - Type Unspecified
VA014001OtherANTHEM BLUE CROSS