Provider Demographics
NPI:1407173172
Name:SULLIVAN, ELIZABETH A (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 RURAL AVE
Mailing Address - Street 2:SUBLEVEL 1
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3246
Mailing Address - Country:US
Mailing Address - Phone:570-321-2345
Mailing Address - Fax:570-321-2359
Practice Address - Street 1:699 RURAL AVE
Practice Address - Street 2:SUBLEVEL 1
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3246
Practice Address - Country:US
Practice Address - Phone:570-321-2345
Practice Address - Fax:570-321-2359
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine