Individual
DR. MARK JOSEPH SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 935-8538
Mailing address
PO BOX 3686, WILMINGTON, NC 28406-0686
(910) 442-1100
(910) 442-1199
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2006-00273
NC
207L00000X
Anesthesiology Physician
Primary
92198
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2054049
MEDICARE ID
NC
01
—
2054049C
MEDICARE PTAN
NC
01
—
2054049E
MEDICARE PTAN
NC
05
—
5903826
—
NC
01
—
P00843366
MEDICARE RAILROAD
NC
Enumeration date
10/28/2005
Last updated
08/23/2024
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