Healthcare Provider Details

I. General information

NPI: 1154582146
Provider Name (Legal Business Name): ELIZABETH HOWE SULLIVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 US ROUTE 1 STE 2
SCARBOROUGH ME
04074-7219
US

IV. Provider business mailing address

144 US ROUTE 1 STE 2
SCARBOROUGH ME
04074-7219
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-7606
  • Fax: 207-819-6802
Mailing address:
  • Phone: 207-396-7606
  • Fax: 207-819-6802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD20834
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number77166-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number268551
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number77166-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: