Provider Demographics
NPI:1477501476
Name:SULLIVAN, CHRISTOPHER P (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
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 1:75 ARCH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1429
Mailing Address - Country:US
Mailing Address - Phone:330-253-1899
Mailing Address - Fax:330-253-2108
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-253-1899
Practice Address - Fax:330-253-2108
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3544533207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0743904Medicaid
0644281Medicare ID - Type Unspecified
SU0644281Medicare UPIN
OHE30138Medicare UPIN