Provider Demographics
NPI:1306866785
Name:SULLIVAN, DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5162
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:70 MEDICAL CENTER CIR STE 302
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2273
Practice Address - Country:US
Practice Address - Phone:540-245-7400
Practice Address - Fax:540-245-7401
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204769208100000X
MDH00534182081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00297124OtherRR MEDICARE
MD325601400Medicaid
MDW2660010OtherMD BLUE SHIELD REGIONAL
MD68576206OtherBLUE SHIELD TRADITIONAL
MD68576206OtherBLUE SHIELD TRADITIONAL
MDW2660010OtherMD BLUE SHIELD REGIONAL