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General NPI Number Information
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NPI Number | 1235127895
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Entity Type | Organization
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Legal Business Name | KEVIN P. SULLIVAN, MD PC
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24 NEWTON ST
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City | SOUTHBOROUGH
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State | MA
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Zip | 01772-1215
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Country | US
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Telephone | 508-481-4700
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Fax | 508-481-2150
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Provider Business Mailing Address
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Address Line | 24 NEWTON ST
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City | SOUTHBOROUGH
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State | MA
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Zip | 01772-1215
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Country | US
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Telephone | 508-481-4700
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Fax | 508-481-2150
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN P SULLIVAN
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Credential | M.D.
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Telephone | 508-481-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 156166
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License Number State | MA
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