Provider Demographics
NPI:1407819790
Name:SUTCLIFFE, HOWARD P (PA-C)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:P
Last Name:SUTCLIFFE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 NW WASHINGTON BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-6384
Mailing Address - Country:US
Mailing Address - Phone:513-867-5770
Mailing Address - Fax:513-737-2468
Practice Address - Street 1:840 NW WASHINGTON BLVD
Practice Address - Street 2:STE. A
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6384
Practice Address - Country:US
Practice Address - Phone:513-867-5770
Practice Address - Fax:513-737-2468
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000325954OtherANTHEM
OH0069963Medicaid
OH36321Medicare PIN
OHQ01034Medicare UPIN
OHH474721Medicare PIN