Healthcare Provider Details

I. General information

NPI: 1831106863
Provider Name (Legal Business Name): KATHLEEN E SULLIVAN M.D. PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MARKET ST FL 3 CHILDREN'S HOSPITAL OF PHILADELPHIA - ALLERGY & IMMUN
PHILADELPHIA PA
19104-3365
US

IV. Provider business mailing address

100 E PENN SQ 9TH FLOOR
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-2549
  • Fax: 215-590-4529
Mailing address:
  • Phone: 267-425-9258
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD050758L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080I0007X
TaxonomyPediatric Clinical & Laboratory Immunology Physician
License NumberMD050758L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberMD050758L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMD050758L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: