Provider Demographics
NPI:1730261991
Name:SUTTON, KYRSTEN E (MD)
Entity type:Individual
Prefix:DR
First Name:KYRSTEN
Middle Name:E
Last Name: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 1:891 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1059
Mailing Address - Country:US
Mailing Address - Phone:207-564-4470
Mailing Address - Fax:207-564-4468
Practice Address - Street 1:891 W MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1064
Practice Address - Country:US
Practice Address - Phone:207-564-4470
Practice Address - Fax:207-564-4468
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20778207VG0400X, 208600000X
SC22119207VG0400X, 207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTS7836Medicaid
H179214423Medicare ID - Type Unspecified
H17921Medicare UPIN