Provider Demographics
NPI:1790746758
Name:SUTTON, MARIANNE B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:B
Last Name:SUTTON
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 1:20 THE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-3136
Mailing Address - Country:US
Mailing Address - Phone:508-498-2196
Mailing Address - Fax:
Practice Address - Street 1:20 THE BLVD
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516-3136
Practice Address - Country:US
Practice Address - Phone:508-498-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31348501208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA30230OtherFALLON
MAJ06574OtherBCBS MS
MA30230OtherFALLON
B98034Medicare UPIN