Provider Demographics
NPI:1245817675
Name:SUTTON, CAESAR
Entity type:Individual
Prefix:
First Name:CAESAR
Middle Name:
Last Name:SUTTON
Suffix:
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 1:1217 PINEVIEW DR APT 13
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-0705
Mailing Address - Country:US
Mailing Address - Phone:304-319-0558
Mailing Address - Fax:
Practice Address - Street 1:1217 PINEVIEW DR APT 13
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0705
Practice Address - Country:US
Practice Address - Phone:304-319-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant