Provider Demographics
NPI:1942399514
Name:SUTTON, LESLIE N (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:N
Last Name:SUTTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 EAST PENN SQUARE
Mailing Address - Street 2:THE WANAMAKER BUILDING 9TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9538
Mailing Address - Fax:267-425-9552
Practice Address - Street 1:34TH & CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-2780
Practice Address - Fax:215-590-4809
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD018318E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000804059Medicaid
PAC31112Medicare UPIN
PA000804059Medicaid