Provider Demographics
NPI:1508814484
Name:SULLIVAN, DONALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
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:PO BOX 1000 DEPT 0194
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-2246
Mailing Address - Country:US
Mailing Address - Phone:901-315-7932
Mailing Address - Fax:
Practice Address - Street 1:9639 FOX HILL CIR N
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-6812
Practice Address - Country:US
Practice Address - Phone:901-315-7932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN260782081P2900X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00219690OtherRAIL ROAD MEDICARE PIN
TN621751285OtherTAX ID NUMBER
TNP00219690OtherRAIL ROAD MEDICARE PIN
TN621751285OtherTAX ID NUMBER