Provider Demographics
NPI:1053786319
Name:SUTTON, EDWARD JR
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SUTTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 OLD YORK ROAD
Mailing Address - Street 2:EINSTEIN MEDICAL CENTER TABOR EMERGENCY PHYSICIANS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141
Mailing Address - Country:US
Mailing Address - Phone:215-456-8037
Mailing Address - Fax:215-456-8502
Practice Address - Street 1:5501 OLD YORK ROAD
Practice Address - Street 2:EINSTEINMEDICAL CENTER TABOR EMERGENCY PHYSICIANS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-456-8037
Practice Address - Fax:215-456-8502
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant