Provider Demographics
NPI:1679801609
Name:SUTHERLAND, CARL MASON II (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:MASON
Last Name:SUTHERLAND
Suffix:II
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 1:539 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2601
Mailing Address - Country:US
Mailing Address - Phone:650-393-4053
Mailing Address - Fax:
Practice Address - Street 1:539 28TH AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2601
Practice Address - Country:US
Practice Address - Phone:650-393-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSMD.03368R2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology