Healthcare Provider Details

I. General information

NPI: 1174632442
Provider Name (Legal Business Name): CATHATL E O'SULLIVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST NEMC BOX 836
BOSTON MA
02111-1526
US

IV. Provider business mailing address

750 WASHINGTON ST NEMC BOX 836
BOSTON MA
02111-1526
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax:
Mailing address:
  • Phone: 617-636-7105
  • Fax: 617-636-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number222391
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: