Provider Demographics
NPI:1407802929
Name:SAUTER, EDWARD R (MD, PHD, MHA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:SAUTER
Suffix:
Gender:M
Credentials:MD, PHD, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3163 CATRINA LN STE 200
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4343
Mailing Address - Country:US
Mailing Address - Phone:240-994-3279
Mailing Address - Fax:
Practice Address - Street 1:4494 PALMER RD N
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-1936
Practice Address - Country:US
Practice Address - Phone:301-295-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10976208600000X
CT054942208600000X, 2086X0206X
MO20020136232086X0206X
TXP38152086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE96010Medicare UPIN
MO205875305Medicaid
MOP00430583Medicare PIN
MO966745236Medicare PIN
MO009011877Medicare PIN
MO920007200Medicare PIN