Provider Demographics
NPI:1518047067
Name:SUTTON, STEVEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:SUTTON
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 1:423 W CORK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3812
Mailing Address - Country:US
Mailing Address - Phone:540-535-1111
Mailing Address - Fax:540-450-1205
Practice Address - Street 1:423 W CORK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3812
Practice Address - Country:US
Practice Address - Phone:540-535-1111
Practice Address - Fax:540-450-1205
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236241208800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010088542Medicaid
VA010083061Medicaid
VA010083061Medicaid
VA108311Medicare UPIN