Provider Demographics
NPI:1316289952
Name:SUTHERLAND, STUART DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:DAVID
Last Name:SUTHERLAND
Suffix:
Gender:M
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 1:555 WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8972
Mailing Address - Country:US
Mailing Address - Phone:802-888-8405
Mailing Address - Fax:
Practice Address - Street 1:555 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8972
Practice Address - Country:US
Practice Address - Phone:802-888-8405
Practice Address - Fax:802-888-8406
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004717363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6700914Medicaid