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General NPI Number Information
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NPI Number | 1245281088
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Entity Type | Individual
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Provider Name | DAVID JAMES SULLIVAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | CARILION MEMORIAL HOSPITAL BELLVIEW AND JEFFERSON STREETS
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City | RAONOKE
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State | VA
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Zip | 24014
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Country | US
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Telephone | 540-981-8250
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Fax |
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Provider Business Mailing Address
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Address Line | 6615 CIRCLE VIEW DR
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City | ROANOKE
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State | VA
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Zip | 24014-6601
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Country | US
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Telephone | 540-776-2939
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0110001586
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License Number State | VA
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