Provider Demographics
NPI:1558652479
Name:COLE-SUTTLAR, CHARLENE DIONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:DIONNE
Last Name:COLE-SUTTLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARKAVIEW RD NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-3652
Mailing Address - Country:US
Mailing Address - Phone:256-553-8477
Mailing Address - Fax:256-534-1580
Practice Address - Street 1:500 MARKAVIEW RD NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-3652
Practice Address - Country:US
Practice Address - Phone:256-533-8477
Practice Address - Fax:256-534-1580
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.3495R207Q00000X
390200000X
AL32053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL163882Medicaid