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1073269320 NPI number — GERROMI SULLIVAN BS, LAT, ATC

NPI Number: 1073269320
Health Care Provider/Practitioner: GERROMI SULLIVAN BS, LAT, ATC

Information about “1073269320” NPI (GERROMI SULLIVAN BS, LAT, ATC) exists in 1073269320 in HTML format HTML  |  1073269320 in plain Text format TXT  |  1073269320 in PDF (Portable Document Format) PDF  |  1073269320 in an XML format XML  formats.

NPI Number : 1073269320 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073269320",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SULLIVAN",
    "FirstName": "GERROMI",
    "MiddleName": null,
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "BS, LAT, ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6110 BREEZEWOOD DR APT 104",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENBELT",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "20770-4148",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "240-602-6626",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1801 TURKEY POINT RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ESSEX",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21221-1734",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "240-602-6626",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/24/2022",
    "LastUpdateDate": "02/24/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "A0001160",
        "LicenseNumberStateCode": "MD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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