Provider Demographics
NPI:1003822149
Name:SUTINGCO, ALEXANDER-NICHOLAS DESIERTO (MD FACEP)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER-NICHOLAS
Middle Name:DESIERTO
Last Name:SUTINGCO
Suffix:
Gender:M
Credentials:MD FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223323
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20153-3323
Mailing Address - Country:US
Mailing Address - Phone:540-349-0595
Mailing Address - Fax:
Practice Address - Street 1:500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3027
Practice Address - Country:US
Practice Address - Phone:540-349-0595
Practice Address - Fax:540-349-0587
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237771207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010169674Medicaid
VA010169461Medicaid
VA007879V59Medicare PIN
VA010169461Medicaid
I34076Medicare UPIN