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NPI Code Detail

MEDICARE: DR. BRIAN P SULLIVAN MD

MEDICARE: DR. BRIAN P 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
1207V00000XObstetrics & Gynecology Physician74990MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21025541OTHERAETNA
3J12638OTHERMABCBS
413867OTHERMAHPHC
5139146OTHERCIGNA
674990OTHERTUFTS

General Provider Information

NPI Number : 1699750265
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN P SULLIVAN MD
Provider Business Mailing Address
First Line : 4 EVERGREEN ST
Second Line :
City : HINGHAM
State : MA
Zip : 02043-1014
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 135 WEBSTER ST
Second Line :
City : HANOVER
State : MA
Zip : 02339-1200
Country : US
Telephone Number : 781-878-7020
Fax Number : 781-871-3590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 04/24/2009

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Directions to “ DR. BRIAN P SULLIVAN MD” Practice Location

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