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NPI Code Detail

MEDICARE: MADISON SULLIVAN

MEDICARE: MADISON SULLIVAN
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1881393544
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON SULLIVAN
Provider Business Mailing Address
First Line : 593 EDDY ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02903-4923
Country : US
Telephone Number : 401-793-2695
Fax Number :
Provider Business Practice Location Address
First Line : 593 EDDY ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02903-4923
Country : US
Telephone Number : 401-793-2695
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2023
Last Update Date : 05/18/2026

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Directions to “ MADISON SULLIVAN ” Practice Location

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