Provider Demographics
NPI:1285709329
Name:SUTTON, JOHN EDWARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:SUTTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:DARTMOUTH-HITCHCOCK MEDICAL CENTER
Mailing Address - Street 2:ONE MEDICAL CENTER DRIVE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756
Mailing Address - Country:US
Mailing Address - Phone:603-650-8022
Mailing Address - Fax:603-650-8030
Practice Address - Street 1:DARTMOUTH-HITCHCOCK MEDICAL CENTER
Practice Address - Street 2:ONE MEDICAL CENTER DRIVE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756
Practice Address - Country:US
Practice Address - Phone:603-650-8022
Practice Address - Fax:603-650-8030
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH6413208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000187Medicaid
VT0000224Medicaid
NHNH0224Medicare ID - Type Unspecified
NH00000187Medicaid