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General NPI Number Information
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NPI Number | 1902074222
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Entity Type | Organization
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Legal Business Name | SABIN J. SULLIVAN, MD, PC
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 975 MASSACHUSETTS AVE
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City | ARLINGTON
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State | MA
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Zip | 02476-4546
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Country | US
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Telephone | 781-643-8556
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Fax | 781-643-8545
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Provider Business Mailing Address
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Address Line | 975 MASSACHUSETTS AVE
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City | ARLINGTON
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State | MA
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Zip | 02476-4546
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Country | US
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Telephone | 781-643-8556
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Fax | 781-643-8545
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SABIN J SULLIVAN
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Credential | MD
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Telephone | 781-643-8556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 77199
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License Number State | MA
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