Provider Demographics
NPI:1972560407
Name:SUTHERLAND, FREDERICK SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:SCOTT
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3650
Practice Address - Fax:704-295-3666
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32212207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10478OtherKANAWHA
NC376583OtherMAMSI
NC11092OtherBCBS MEDPOINT
SC000000295033OtherUNISON HEALTH PLAN SC
NC100705OtherWELLNESS
SC20093347OtherSELECT HEALTH OF SC
SCN32212Medicaid
180021443OtherRAILROAD MEDICARE
NC36362OtherMEDCOST
NC141018OtherCOVENTRY
NC2630782002OtherCIGNA
NC81056OtherBCBS
NC6182OtherDOCTORS HEALTH PLAN
NC6679OtherPARTNERS
NC7472OtherWELLPATH
NC0841437OtherUNITED HEALTHCARE
NC4116519OtherAETNA
NC8981056Medicaid
NC0841437OtherUNITED HEALTHCARE
NC4116519OtherAETNA
E48194Medicare UPIN