Active NPI
Mark Alan Sutherlin, ATC
- Athletic Trainer
- Charlottesville, VA
National Provider Identifier
1922322627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 104.0000172
- Practice address
- 210 Emmet St S
Charlottesville, VA 22903 - Phone
- (434) 924-6184
- NPI assigned
- Mar 24, 2010
- Last updated
- Sep 5, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 104.0000172 | VT | Primary |
Addresses
Primary practice location
210 Emmet St S
Charlottesville, VA 22903
Mailing address
210 Emmet St S.
Charlottesville, VA 22903
Phone (434) 924-6184
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104.0000172 | VT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409875200000",
"number": "1922322627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 EMMET ST S.",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "22903",
"telephone_number": "434-924-6184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 EMMET ST S",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "22903",
"telephone_number": "434-924-6184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTHERLIN",
"first_name": "MARK",
"middle_name": "ALAN",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-24",
"last_updated": "2014-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VT",
"license": "104.0000172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlottesville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.