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General NPI Number Information
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NPI Number | 1306820014
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Entity Type | Individual
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Provider Name | BRIAN P O'SULLIVAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 5 WASHINGTON PL DEPARTMENT OF PEDIATRIC PULMONOLOGY
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City | BEDFORD
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State | NH
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Zip | 03110-6736
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Country | US
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Telephone | 603-695-2790
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Fax | 603-629-1785
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Provider Business Mailing Address
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Address Line | 5 WASHINGTON PL
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City | BEDFORD
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State | NH
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Zip | 03110-6736
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Country | US
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Telephone | 603-695-2790
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Fax | 603-629-1785
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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 | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 52083
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 16770
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License Number State | NH
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