Provider Demographics
NPI:1558321349
Name:SUTTON, THADDEUS G (MD)
Entity Type:Individual
Prefix:
First Name:THADDEUS
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 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 2200
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6251
Practice Address - Country:US
Practice Address - Phone:757-251-2170
Practice Address - Fax:757-251-2185
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016924R53Medicare PIN
VAP00604188Medicare PIN
VA1558321349Medicaid
E67348Medicare UPIN