Provider Demographics
NPI:1730480088
Name:PETER R. SUTTER, D.O., INC
Entity Type:Organization
Organization Name:PETER R. SUTTER, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT.OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-745-3428
Mailing Address - Street 1:105 5TH ST SE
Mailing Address - Street 2:STE. 2
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4255
Mailing Address - Country:US
Mailing Address - Phone:330-745-3428
Mailing Address - Fax:330-745-7002
Practice Address - Street 1:105 5TH ST SE
Practice Address - Street 2:STE. 2
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4255
Practice Address - Country:US
Practice Address - Phone:330-745-3428
Practice Address - Fax:330-745-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4609-S207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0959055Medicaid
1699759837OtherINDIVIDUAL NPI
OHSU0657645Medicare PIN
OHE32437Medicare UPIN