Provider Demographics
NPI:1720193691
Name:SUTTON, IRA (MD)
Entity Type:Individual
Prefix:
First Name:IRA
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 1:2 OVERHILL RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5323
Mailing Address - Country:US
Mailing Address - Phone:914-636-0077
Mailing Address - Fax:914-636-5116
Practice Address - Street 1:2 OVERHILL RD
Practice Address - Street 2:SUITE 225
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5323
Practice Address - Country:US
Practice Address - Phone:914-636-0077
Practice Address - Fax:914-636-5116
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA42368Medicare UPIN
NY77D411Medicare ID - Type Unspecified