Provider Demographics
NPI:1801834338
Name:SUTTER, GARRETT GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:GERALD
Last Name:SUTTER
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 1:753 N KINGS RD
Mailing Address - Street 2:APT. #302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5481
Mailing Address - Country:US
Mailing Address - Phone:323-655-3269
Mailing Address - Fax:
Practice Address - Street 1:750 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-4143
Practice Address - Country:US
Practice Address - Phone:609-394-6063
Practice Address - Fax:609-278-5407
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77982207P00000X
NJ25MA09097300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A779820Medicaid
CAWA77982FMedicare PIN
CAH80387Medicare UPIN
CAWA77982Medicare PIN