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NPI Code Detail

MEDICARE: BRONYA BOYKIN SULLIVAN M.D.

MEDICARE: BRONYA BOYKIN 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
12084P0800XPsychiatry Physician054553GA
22084P0800XPsychiatry Physician35.095997OH
32084P0800XPsychiatry Physician036.123716IL

General Provider Information

NPI Number : 1619971280
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRONYA BOYKIN SULLIVAN M.D.
Provider Business Mailing Address
First Line : 2200 W BROAD ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43223-1297
Country : US
Telephone Number : 614-752-0333
Fax Number :
Provider Business Practice Location Address
First Line : 2200 W BROAD ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43223-1297
Country : US
Telephone Number : 614-752-0333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 02/01/2011

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