Provider Demographics
NPI:1770745903
Name:SUTINGCO, NICANOR C
Entity type:Individual
Prefix:DR
First Name:NICANOR
Middle Name:C
Last Name:SUTINGCO
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 1:2214 EXECUTIVE DR
Mailing Address - Street 2:STE. B
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6606
Mailing Address - Country:US
Mailing Address - Phone:757-826-3733
Mailing Address - Fax:
Practice Address - Street 1:2214 EXECUTIVE DR
Practice Address - Street 2:STE. B
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6606
Practice Address - Country:US
Practice Address - Phone:757-826-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028727207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine