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General NPI Number Information
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NPI Number | 1851852560
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Entity Type | Individual
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Provider Name | SULLIVAN MCINTOSH SMITH MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 41 MALL RD
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City | BURLINGTON
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State | MA
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Zip | 01805-3328
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Country | US
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Telephone | 781-744-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24520
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City | NEW YORK
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State | NY
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Zip | 10087-3720
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Country | US
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Telephone | 781-744-8085
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 125.074394
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 1021889
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License Number State | MA
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