Provider Demographics
NPI:1154304897
Name:SULLIVAN, GREGORY B (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-6340
Mailing Address - Fax:717-851-6349
Practice Address - Street 1:3550 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8626
Practice Address - Country:US
Practice Address - Phone:717-851-6340
Practice Address - Fax:717-851-6349
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037811E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011550090006Medicaid
E12840Medicare UPIN
PA053360GU1Medicare ID - Type Unspecified