Provider Demographics
NPI:1144216938
Name:SULLIVAN, THEODORE ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ROBERT
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 HIGHLAND AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3714
Mailing Address - Country:US
Mailing Address - Phone:215-887-3990
Mailing Address - Fax:215-887-1140
Practice Address - Street 1:1245 HIGHLAND AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3714
Practice Address - Country:US
Practice Address - Phone:215-887-3990
Practice Address - Fax:215-887-1140
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041868L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery