Provider Demographics
NPI:1851366686
Name:SUTTON, MALA V (MD)
Entity Type:Individual
Prefix:DR
First Name:MALA
Middle Name:V
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:130 CENTERWAY
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830
Practice Address - Country:US
Practice Address - Phone:607-936-9971
Practice Address - Fax:607-936-2600
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00467616Medicaid
NY080174240OtherRR MEDICARE PIN
PA0010839930003Medicaid
NYCC8362OtherRR MEDICARE GROUP
NYCC8362OtherRR MEDICARE GROUP
NY00467616Medicaid