Provider Demographics
NPI:1831116748
Name:SUTCLIFFE, ERNEST A (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:A
Last Name:SUTCLIFFE
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 1:65 WALNUT ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2118
Mailing Address - Country:US
Mailing Address - Phone:781-237-1580
Mailing Address - Fax:781-237-6382
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 330
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-237-1580
Practice Address - Fax:781-237-6382
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47551207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6171257Medicaid
MASUJ02245OtherBLUE CROSS
MAA56465Medicare UPIN
MA6171257Medicaid