MEDICARE: SUSAN KATHLEEN SULLIVAN M.ED.

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1598031999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN KATHLEEN SULLIVAN M.ED.

Provider Business Mailing Address
First Line	:	3 CHURCH CIR STE 312
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-1933
Country	:	US
Telephone Number	:	443-699-0619
Fax Number	:

Provider Business Practice Location Address
First Line	:	3123 CATRINA LN
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-4340
Country	:	US
Telephone Number	:	443-699-0619
Fax Number	:

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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