Provider Demographics
NPI:1417917030
Name:SUTHERIN, STEVEN R (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:SUTHERIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2350 MIAMI VALLEY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4778
Mailing Address - Country:US
Mailing Address - Phone:937-228-1731
Mailing Address - Fax:937-228-8622
Practice Address - Street 1:2350 MIAMI VALLEY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4778
Practice Address - Country:US
Practice Address - Phone:937-228-1731
Practice Address - Fax:937-228-8622
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35051328208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0705571Medicaid
OHD97997Medicare UPIN
OH0705571Medicaid