Provider Demographics
NPI:1962605360
Name:SUTTON, AMELIA LOUISE MAPLE (MD)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:LOUISE MAPLE
Last Name:SUTTON
Suffix:
Gender:F
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-5701
Mailing Address - Fax:704-384-5642
Practice Address - Street 1:1718 E 4TH ST STE 404
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-384-5701
Practice Address - Fax:704-384-5642
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD. 29318208D00000X
390200000X
NC2018-00975207VM0101X
NC1013680207SM0001X
AL29318207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic Pathology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051116355OtherBLUE CROSS
AL051116359OtherBLUE CROSS
AL051116363OtherBLUE CROSS
AL128012Medicaid
AL128014Medicaid
AL051116353OtherBLUE CROSS
AL051116354OtherBLUE CROSS
AL128005Medicaid
AL051116326OtherBLUE CROSS
AL051116362OtherBLUE CROSS
ALR9667Medicaid
AL051116352OtherBLUE CROSS
AL051116356OtherBLUE CROSS
MS09355366Medicaid
AL127997Medicaid
AL051116358OtherBLUE CROSS
AL051116361OtherBLUE CROSS
AL128004Medicaid
AL128016Medicaid
AL051116351OtherBLUE CROSS
AL127993Medicaid
AL127999Medicaid
AL128021Medicaid
AL051116357OtherBLUE CROSS
AL051116364OtherBLUE CROSS
AL128002Medicaid
AL128011Medicaid
AL127994Medicaid
AL128001Medicaid
AL128018Medicaid
AL051116363OtherBLUE CROSS