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General NPI Number Information
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NPI Number | 1841292562
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Entity Type | Individual
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Provider Name | MITCHELL SULLIVAN MD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 195 INDUSTRIAL PKWY
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City | LYNDONVILLE
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State | VT
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Zip | 05851-4511
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Country | US
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Telephone | 802-748-9501
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Fax | 802-748-3420
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Provider Business Mailing Address
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Address Line | PO BOX 83
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City | LYNDONVILLE
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State | VT
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Zip | 05851-0083
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Country | US
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Telephone | 802-748-9501
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Fax | 802-748-3420
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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 | 9367
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License Number State | NH
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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 | 042-0012982
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License Number State | VT
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