Provider Demographics
NPI:1306820014
Name:O'SULLIVAN, BRIAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6736
Mailing Address - Country:US
Mailing Address - Phone:603-695-2790
Mailing Address - Fax:603-629-1785
Practice Address - Street 1:5 WASHINGTON PL
Practice Address - Street 2:DEPARTMENT OF PEDIATRIC PULMONOLOGY
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6736
Practice Address - Country:US
Practice Address - Phone:603-695-2790
Practice Address - Fax:603-629-1785
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA520832080P0214X
NH167702080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6175368Medicaid
MAA2931601Medicare PIN
MAE01830Medicare UPIN