Provider Demographics
NPI:1457672024
Name:SULLIVANI, BAIDAA N (MD)
Entity Type:Individual
Prefix:
First Name:BAIDAA
Middle Name:N
Last Name:SULLIVANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BAIDAA
Other - Middle Name:N
Other - Last Name:MOHAMMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3136 TURNBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7489
Mailing Address - Country:US
Mailing Address - Phone:585-747-4025
Mailing Address - Fax:
Practice Address - Street 1:3136 TURNBERRY CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7489
Practice Address - Country:US
Practice Address - Phone:585-747-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254274208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01226875Medicare PIN
VAVVA391AMedicare PIN