MEDICARE: DR. DONALD J SULLIVAN MD

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	26078	TN
2	208M00000X	Hospitalist Physician	26078	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00219690	OTHER	TN	RAIL ROAD MEDICARE PIN

General Provider Information

NPI Number	:	1508814484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD J SULLIVAN MD

Provider Business Mailing Address
First Line	:	PO BOX 1000 DEPT 0194
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-2246
Country	:	US
Telephone Number	:	901-315-7932
Fax Number	:

Provider Business Practice Location Address
First Line	:	9639 FOX HILL CIR N
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38139-6812
Country	:	US
Telephone Number	:	901-315-7932
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/09/2024

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