Provider Demographics
NPI:1053411561
Name:MORROW-SUTTON, MARY ARDESAR (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ARDESAR
Last Name:MORROW-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 1:968 GREGS DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-5553
Mailing Address - Country:US
Mailing Address - Phone:770-484-4842
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8156
Practice Address - Fax:717-531-6776
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211388390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000876873KMedicaid
GA000876873KMedicaid
GA000876873KMedicaid