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NPI Code Detail

MEDICARE: DR. MARY P SULLIVAN D.O.

MEDICARE: DR. MARY P SULLIVAN D.O.
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
1207P00000XEmergency Medicine PhysicianDO832FL
2207P00000XEmergency Medicine PhysicianDO832AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1051000772OTHERALBLUE CROSS&BLUE SHIELD

General Provider Information

NPI Number : 1841201118
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY P SULLIVAN D.O.
Provider Business Mailing Address
First Line : 1815 HAND AVE
Second Line :
City : BAY MINETTE
State : AL
Zip : 36507-4110
Country : US
Telephone Number : 251-937-5521
Fax Number :
Provider Business Practice Location Address
First Line : 1815 HAND AVE
Second Line :
City : BAY MINETTE
State : AL
Zip : 36507-4110
Country : US
Telephone Number : 251-580-1717
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 10/16/2024

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