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General NPI Number Information
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NPI Number | 1306137518
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Entity Type | Organization
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Legal Business Name | IRIS SULLIVAN MD PC
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 46 WHALON STREET
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City | FITCHBURG
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State | MA
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Zip | 01420
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Country | US
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Telephone | 978-342-4500
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Fax | 978-342-4600
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Provider Business Mailing Address
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Address Line | 46 WHALON
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City | FITCHBURG
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State | MA
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Zip | 01420
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Country | US
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Telephone | 978-342-4500
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Fax | 978-342-4600
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Authorized Official
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Title or Position | PHYSICIAN
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Name | IRIS SULLIVAN
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Credential | M.D.
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Telephone | 978-342-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN281239
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License Number State | MA
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