Provider Demographics
NPI:1952347569
Name:SUTHERLAND, ELIZABETH ANNE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:HETHERINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:869 ACKERMAN DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1849
Mailing Address - Country:US
Mailing Address - Phone:925-718-8956
Mailing Address - Fax:
Practice Address - Street 1:869 ACKERMAN DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1849
Practice Address - Country:US
Practice Address - Phone:925-718-8956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28165207L00000X
CAG404632083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ515645Medicaid
AZZ109924Medicare PIN
AZZ109975Medicare PIN
AZZ1009923Medicare PIN
AZZ113666Medicare PIN
AZZ109930Medicare PIN
AZ515645Medicaid
AZZ109928Medicare PIN
AZZ109929Medicare PIN
AZZ109922Medicare PIN
AZZ109927Medicare PIN
AZZ109926Medicare PIN
AZZ109974Medicare PIN
A48230Medicare UPIN
AZZ109925Medicare PIN