Provider Demographics
NPI:1306957527
Name:SUTTON, ERNEST LORAN (MD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:LORAN
Last Name:SUTTON
Suffix:
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 1:800 IRVING AVE
Mailing Address - Street 2:MSC 111 G
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2716
Mailing Address - Country:US
Mailing Address - Phone:412-897-3405
Mailing Address - Fax:315-425-2647
Practice Address - Street 1:800 IRVING AVE
Practice Address - Street 2:MSC 111 G
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2716
Practice Address - Country:US
Practice Address - Phone:412-897-3405
Practice Address - Fax:315-425-2647
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-053364207RG0100X
PAMD431386207RG0100X
OH35.096129207RG0100X
VA0101259170207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019433630002Medicaid
PA1019433630001Medicaid
OH2986309Medicaid
PA1019433630001Medicaid
PA112496YBNZMedicare PIN
PAZ99883Medicare UPIN
OH2986309Medicaid