Provider Demographics
NPI:1275676751
Name:SULLIVAN, ALBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:L
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 1:1210 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3322
Mailing Address - Country:US
Mailing Address - Phone:617-424-6138
Mailing Address - Fax:
Practice Address - Street 1:1319 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4736
Practice Address - Country:US
Practice Address - Phone:305-294-8812
Practice Address - Fax:305-292-9466
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114637207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology