Provider Demographics
NPI:1780855148
Name:SUTHERLAND, ANNE KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:KATHLEEN
Last Name:SUTHERLAND
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 1:150 BERGEN ST
Mailing Address - Street 2:UNIVERSITY HOSPITAL, ROOM I-354
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2496
Mailing Address - Country:US
Mailing Address - Phone:973-973-6111
Mailing Address - Fax:973-972-0128
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:UNIVERSITY HOSPITAL, ROOM I-354
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-973-6111
Practice Address - Fax:973-972-0128
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230068207RC0200X, 207RP1001X
NJ25MA09424400207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03052040Medicaid
NJ342727Medicare UPIN
NY03052040Medicaid