MEDICARE: MARGUERITE 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
1	207N00000X	Dermatology Physician	276802	MA

General Provider Information

NPI Number	:	1811420532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGUERITE SULLIVAN M.D.

Provider Business Mailing Address
First Line	:	1 WASHINGTON ST STE 401
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-1737
Country	:	US
Telephone Number	:	781-416-3500
Fax Number	:	781-416-3505

Provider Business Practice Location Address
First Line	:	1 WASHINGTON ST STE 401
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-1737
Country	:	US
Telephone Number	:	781-416-3500
Fax Number	:	781-416-3505

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

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	10/02/2025

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