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General NPI Number Information
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NPI Number | 1730179607
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Entity Type | Individual
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Provider Name | JAMES D SULLIVAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 200 HIGH SERVICE AVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-5113
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Country | US
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Telephone | 401-456-3402
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Fax |
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Provider Business Mailing Address
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Address Line | 3 CENTURY DR
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City | PARSIPPANY
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State | NJ
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Zip | 07054-4610
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Country | US
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Telephone | 973-251-1018
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Fax | 973-740-9895
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 72262
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD09038
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License Number State | RI
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