Provider Demographics
NPI:1194909978
Name:SUTHERLAND, JESSICA ARLENE (MD)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ARLENE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-773-9992
Mailing Address - Fax:603-778-6393
Practice Address - Street 1:3 ALUMNI DR STE 101
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2122
Practice Address - Country:US
Practice Address - Phone:603-773-9992
Practice Address - Fax:603-778-6393
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14608207RC0000X, 207RI0011X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075283Medicaid
NH00053302Medicare PIN