Healthcare Provider Details

I. General information

NPI: 1821525312
Provider Name (Legal Business Name): CATHLYN SULLIVAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST STE 200
PORTLAND ME
04102-3166
US

IV. Provider business mailing address

887 CONGRESS ST STE 200
PORTLAND ME
04102-3166
US

V. Phone/Fax

Practice location:
  • Phone: 207-771-5549
  • Fax: 207-771-7834
Mailing address:
  • Phone: 207-771-5549
  • Fax: 207-771-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDOS-2164
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberDO3886
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberDO3886
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO3886
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: