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General NPI Number Information
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NPI Number | 1437565488
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Entity Type | Individual
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Provider Name | THOMAS BARRETT SULLIVAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 13710 ST FRANCIS BLVD STE 605
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-3267
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Country | US
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Telephone | 804-764-7365
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 232410
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City | SAN DIEGO
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State | CA
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Zip | 92193-2410
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Country | US
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Telephone |
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 0101284016
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | A138132
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License Number State | CA
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