Healthcare Provider Details

I. General information

NPI: 1295012060
Provider Name (Legal Business Name): TIMOTHY ERIC SULLIVAN JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 STATE RD
LANCASTER PA
17601-1812
US

IV. Provider business mailing address

307 LAKESIDE XING
MOUNT JOY PA
17552-9061
US

V. Phone/Fax

Practice location:
  • Phone: 223-287-8155
  • Fax: 717-312-3143
Mailing address:
  • Phone: 717-598-8531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00271500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA056911
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: