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NPI Code Detail

MEDICARE: DR. SUZANNE E. SULLIVAN MD

MEDICARE: DR. SUZANNE E. 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
1207R00000XInternal Medicine PhysicianD0062242MD

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00201779OTHERMDRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
164441701OTHERMDCAREFIRST BCBS
20026OTHERDCCAREFIRST BCBS
37792782OTHERMDAETNA PPO
51223835OTHERMDAETNA HMO

General Provider Information

NPI Number : 1992705578
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUZANNE E. SULLIVAN MD
Provider Business Mailing Address
First Line : PO BOX 64916
Second Line :
City : BALTIMORE
State : MD
Zip : 21264-4916
Country : US
Telephone Number : 410-216-6481
Fax Number : 410-280-6515
Provider Business Practice Location Address
First Line : 2001 MEDICAL PKWY
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21401-3280
Country : US
Telephone Number : 443-481-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 10/18/2007

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