Provider Demographics
NPI:1205222841
Name:SULLIVAN, MEGHAN ELIZABETH (MS, ATC, CES, PES)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS, ATC, CES, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7931 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:21226-2033
Mailing Address - Country:US
Mailing Address - Phone:301-648-6960
Mailing Address - Fax:410-455-1191
Practice Address - Street 1:1000 HILLTOP CIR
Practice Address - Street 2:RAC 221
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21250-0001
Practice Address - Country:US
Practice Address - Phone:410-455-1664
Practice Address - Fax:410-455-1191
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00002252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer