Provider Demographics
NPI:1689681264
Name:SUTTON, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
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:PO BOX 2152
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-2152
Mailing Address - Country:US
Mailing Address - Phone:828-277-1300
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:2824 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7803
Practice Address - Country:US
Practice Address - Phone:570-522-8111
Practice Address - Fax:570-522-0129
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021323E207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006917230001Medicaid
PAP00373159Medicare PIN
PA006917230001Medicaid