1750558896 NPI number — MRS. VALERIE WAGNER SUTTON MS FAAA

Table of content: MRS. VALERIE WAGNER SUTTON MS FAAA (NPI 1750558896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750558896 NPI number — MRS. VALERIE WAGNER SUTTON MS FAAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUTTON
Provider First Name:
VALERIE
Provider Middle Name:
WAGNER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS FAAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750558896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 MILFORD ST
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-6966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-315-5888
Provider Business Mailing Address Fax Number:
301-315-5866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9420 KEY WEST AVE
Provider Second Line Business Practice Location Address:
SUITE 430
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-315-5888
Provider Business Practice Location Address Fax Number:
301-315-5866
Provider Enumeration Date:
05/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  00244 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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