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NPI Code Detail

MEDICARE: CHRISTINE M SULLIVAN M.D.

MEDICARE: CHRISTINE M 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
1174400000XSpecialist35060511SOH

General Provider Information

NPI Number : 1598751752
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE M SULLIVAN M.D.
Provider Business Mailing Address
First Line : 7706 OLENTANGY RIVER RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43235-1317
Country : US
Telephone Number : 614-436-8888
Fax Number : 614-436-8847
Provider Business Practice Location Address
First Line : 7706 OLENTANGY RIVER RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43235-1317
Country : US
Telephone Number : 614-436-8888
Fax Number : 614-436-8847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 07/08/2007

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