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1841292562

NPI Code Detail

MEDICARE: MITCHELL SULLIVAN MD

MEDICARE: MITCHELL SULLIVAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	9367	NH
2	207Q00000X	Family Medicine Physician	042-0012982	VT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	930044719	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160094	OTHER	NH	CIGNA HEALTHCARE
2	0106084YPNH01	OTHER	NH	ANTHEM BC/BS
3	5830418	OTHER		AETNA GROUP
4	9367	OTHER	NH	STATE LICENSE #
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841292562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL SULLIVAN MD

Provider Business Mailing Address
First Line	:	PO BOX 83
Second Line	:
City	:	LYNDONVILLE
State	:	VT
Zip	:	05851-0083
Country	:	US
Telephone Number	:	802-748-9501
Fax Number	:	802-748-3420

Provider Business Practice Location Address
First Line	:	195 INDUSTRIAL PKWY
Second Line	:
City	:	LYNDONVILLE
State	:	VT
Zip	:	05851-4511
Country	:	US
Telephone Number	:	802-748-9501
Fax Number	:	802-748-3420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	03/07/2023

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Directions to “ MITCHELL SULLIVAN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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