Provider Demographics
NPI:1699759837
Name:SUTTER, PETER RAYMOND (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:RAYMOND
Last Name:SUTTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 5TH ST SE
Mailing Address - Street 2:STE. 2
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4255
Mailing Address - Country:US
Mailing Address - Phone:330-745-3428
Mailing Address - Fax:330-745-7002
Practice Address - Street 1:105 5TH ST SE
Practice Address - Street 2:STE. 2
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4255
Practice Address - Country:US
Practice Address - Phone:330-745-3428
Practice Address - Fax:330-745-7002
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4609-S207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000194995OtherBLUE CROSS/BLUE SHIELD
OH34194777527OtherCARESOURCE
OH0969055Medicaid
OH341106769COtherSUMMACARE
OH34194777527OtherCARESOURCE
OH0969055Medicaid