Provider Demographics
NPI:1811978158
Name:SUTTON, SIDNEY MICHAEL SR (MD)
Entity type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:MICHAEL
Last Name:SUTTON
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 N ROAD ST STE G
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3354
Mailing Address - Country:US
Mailing Address - Phone:252-337-9120
Mailing Address - Fax:855-330-7320
Practice Address - Street 1:1141 N ROAD ST STE G
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3354
Practice Address - Country:US
Practice Address - Phone:252-337-9120
Practice Address - Fax:855-330-7320
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900660Medicaid
NC2319001Medicare PIN
NC5900660Medicaid