Provider Demographics
NPI:1093770356
Name:SULLIVAN BURKLOW, CAROLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:SULLIVAN BURKLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9904 WILLOW TREE TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5473
Mailing Address - Country:US
Mailing Address - Phone:301-251-6179
Mailing Address - Fax:
Practice Address - Street 1:4954 N PALMER RD
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS, WRNMMC
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5630
Practice Address - Country:US
Practice Address - Phone:301-319-2825
Practice Address - Fax:301-295-5069
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD40265208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics