Healthcare Provider Details

I. General information

NPI: 1275843708
Provider Name (Legal Business Name): RACHEL SULLIVAN M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PLAIN ST SUITE 203
PROVIDENCE RI
02905-3240
US

IV. Provider business mailing address

235 PLAIN ST SUITE 203
PROVIDENCE RI
02905-3240
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-4901
  • Fax: 401-649-4903
Mailing address:
  • Phone: 401-649-4901
  • Fax: 401-649-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL AILEEN SULLIVAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-617-2032