Provider Demographics
NPI:1487639191
Name:SUTTER, DAVID BRAND (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRAND
Last Name:SUTTER
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 1:638 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1734
Mailing Address - Country:US
Mailing Address - Phone:201-848-1731
Mailing Address - Fax:
Practice Address - Street 1:638 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1734
Practice Address - Country:US
Practice Address - Phone:201-848-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03126800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7271107Medicaid
NJ25MA03126800OtherSTATE LICENSE
31D0110140OtherCLIA NUMBER
NJD01934300OtherSTATE CDS NUMBER
NJD01934300OtherSTATE CDS NUMBER
NJD01934300OtherSTATE CDS NUMBER
NJ25MA03126800OtherSTATE LICENSE
NJ7271107Medicaid
NJ25MA03126800OtherSTATE LICENSE