Healthcare Provider Details

I. General information

NPI: 1033232293
Provider Name (Legal Business Name): KAREN ANN SULLIVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 PROVIDENCE RD STE 301
VIRGINIA BEACH VA
23464-4122
US

IV. Provider business mailing address

5320 PROVIDENCE RD STE 301
VIRGINIA BEACH VA
23464-4122
US

V. Phone/Fax

Practice location:
  • Phone: 757-413-7600
  • Fax: 757-413-7601
Mailing address:
  • Phone: 757-413-7600
  • Fax: 757-413-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101057482
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: