MEDICARE: MARK A SULLIVAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	40783	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215036603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A SULLIVAN M.D.

Provider Business Mailing Address
First Line	:	LAHEY CLINIC
Second Line	:	41 MALL ROAD
City	:	BURLINGTON
State	:	MA
Zip	:	01805-0001
Country	:	US
Telephone Number	:	781-641-0100
Fax Number	:	781-744-7132

Provider Business Practice Location Address
First Line	:	37 BROADWAY
Second Line	:	LAHEY ARLINGTON
City	:	ARLINGTON
State	:	MA
Zip	:	02474-5552
Country	:	US
Telephone Number	:	781-641-0100
Fax Number	:	781-744-7132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	12/05/2012

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