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General NPI Number Information
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NPI Number | 1053585661
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Entity Type | Organization
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Legal Business Name | PATRICIA M. SULLIVAN, MD, LLC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 10796 HICKORY RIDGE RD
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City | COLUMBIA
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State | MD
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Zip | 21044-3646
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Country | US
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Telephone | 240-535-8968
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Fax |
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Provider Business Mailing Address
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Address Line | 10796 HICKORY RIDGE RD
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City | COLUMBIA
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State | MD
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Zip | 21044-3646
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Country | US
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Telephone | 240-535-8968
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA M SULLIVAN
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Credential | M.D.
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Telephone | 240-535-8968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | D0055226
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License Number State | MD
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