Provider Demographics
NPI:1518919836
Name:SULLIVAN, ELEANOR R (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:R
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3040
Mailing Address - Country:US
Mailing Address - Phone:508-778-8818
Mailing Address - Fax:
Practice Address - Street 1:125 UNDERPASS RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-1810
Practice Address - Country:US
Practice Address - Phone:508-864-3779
Practice Address - Fax:888-275-9498
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72694207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA072694OtherTUFTS
MA25008433OtherUNITED HEALTH CARE
MA2580624OtherAETNA
MA0057799OtherCIGNA
MA060063844OtherRR MEDICARE
MA300296OtherHPHC
MA3126587Medicaid
MAJ30487OtherBLUE SHIELD
MAJ30487OtherBLUE SHIELD
MA2580624OtherAETNA