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General NPI Number Information
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NPI Number | 1740443118
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Entity Type | Individual
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Provider Name | ALICE PRESCOTT SULLIVAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | PO BOX 877
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City | COLUMBIA
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State | MD
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Zip | 21044-0877
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Country | US
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Telephone | 707-308-8675
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Fax | 855-488-4577
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Provider Business Mailing Address
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Address Line | PO BOX 877
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City | COLUMBIA
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State | MD
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Zip | 21044-0877
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Country | US
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Telephone | 512-777-9804
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Fax | 855-488-4577
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 98423
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0101656
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34.013517
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License Number State | OH
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