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General NPI Number Information
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NPI Number | 1205222841
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Entity Type | Individual
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Provider Name | MEGHAN ELIZABETH SULLIVAN MS, ATC, CES, PES
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Gender | Female
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 1000 HILLTOP CIR RAC 221
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City | BALTIMORE
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State | MD
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Zip | 21250-0001
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Country | US
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Telephone | 410-455-1664
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Fax | 410-455-1191
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Provider Business Mailing Address
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Address Line | 7931 MAIN ST
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City | ORCHARD BEACH
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State | MD
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Zip | 21226-2033
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Country | US
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Telephone | 301-648-6960
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Fax | 410-455-1191
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A0000225
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License Number State | MD
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