Healthcare Provider Details

I. General information

NPI: 1447824297
Provider Name (Legal Business Name): ZACHARY SULLIVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 HARRISON AVE
BOSTON MA
02118-2905
US

IV. Provider business mailing address

820 HARRISON AVE
BOSTON MA
02118-2905
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8000
  • Fax:
Mailing address:
  • Phone: 617-638-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036177986
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: