Provider Demographics
NPI:1215985106
Name:SUTHERLAND, ELISABETH A (PA-C)
Entity type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:A
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:9 STEARNS LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8850
Practice Address - Country:US
Practice Address - Phone:570-271-6784
Practice Address - Fax:570-271-5268
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q08016Medicare UPIN
PA076600Medicare ID - Type Unspecified