Healthcare Provider Details

I. General information

NPI: 1952321135
Provider Name (Legal Business Name): JOSEPH E SULLIVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE FL 8 BOX 0348
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

400 PARNASSUS AVE FL 8 BOX 0348
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2437
  • Fax: 415-353-2837
Mailing address:
  • Phone: 415-353-2437
  • Fax: 415-353-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA99923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: