Provider Demographics
NPI:1124196001
Name:GLORIEUX-SULLIVAN, DELPHINE (MD)
Entity Type:Individual
Prefix:
First Name:DELPHINE
Middle Name:
Last Name:GLORIEUX-SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DELPHINE
Other - Middle Name:
Other - Last Name:GLORIEUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:59 PAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3531
Mailing Address - Country:US
Mailing Address - Phone:603-752-2300
Mailing Address - Fax:603-752-8231
Practice Address - Street 1:7 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3531
Practice Address - Country:US
Practice Address - Phone:603-752-2300
Practice Address - Fax:603-752-8231
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10170207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH201410OtherCIGNA NH
NH2608304OtherCIGNA AVH SURGICAL ASSOCI
NHG63879OtherHPHC
NH0100422Y0NH01OtherANTHEM SURGICAL ASSOCIATE
NH30010899OtherMEDICAID PIN
NH0100422Y0NH02OtherBCBS ANTHEM
NH30201309Medicaid
NH30010899OtherMEDICAID PIN
NHG63879Medicare UPIN
NHRE7915Medicare PIN