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General NPI Number Information
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NPI Number | 1235209271
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Entity Type | Organization
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Legal Business Name | JOHN M. SULLIVAN, M.D. AND ASSOCIATES LLC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 1001 S MARKET ST SUITE B
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City | MECHANICSBURG
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State | PA
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Zip | 17055-4748
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Country | US
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Telephone | 717-697-5050
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Fax | 717-591-0920
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Provider Business Mailing Address
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Address Line | 1001 S MARKET ST SUITE B
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City | MECHANICSBURG
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State | PA
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Zip | 17055-4748
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Country | US
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Telephone | 717-697-5050
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Fax | 717-591-0920
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Authorized Official
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Title or Position | OWNER
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Name | JOHN M SULLIVAN
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Credential | M.D.
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Telephone | 717-697-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | MD018511-E
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License Number State | PA
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