Provider Demographics
NPI:1700902046
Name:SUTTER, JOHN PATRICK
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:SUTTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NORTH GLEBE RD SUITE 104
Mailing Address - Street 2:PHOENIX HOUSE MID ATLANTIC
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203
Mailing Address - Country:US
Mailing Address - Phone:703-841-0703
Mailing Address - Fax:703-243-0975
Practice Address - Street 1:200 NORTH GLEBE RD SUITE 104
Practice Address - Street 2:PHOENIX HOUSE MID ATLANTIC
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-841-0703
Practice Address - Fax:703-243-0975
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036177207Q00000X
VA0101263708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine