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General NPI Number Information
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NPI Number | 1720207459
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Entity Type | Individual
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Provider Name | DR. ROBERT E SULLIVAN
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2116 HARPERS MILL RD
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-7521
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Country | US
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Telephone | 757-565-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 16086 SERENITY POINT LN
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City | ROGERS
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State | AR
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Zip | 72756-8610
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Country | US
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Telephone | 479-925-7713
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101048608
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License Number State | VA
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