Provider Demographics
NPI:1558321562
Name:SULLIVAN, MAUREEN (NP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 E CONCORD ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2335
Mailing Address - Country:US
Mailing Address - Phone:617-414-5167
Mailing Address - Fax:617-414-7300
Practice Address - Street 1:850 HARRISON AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4072
Practice Address - Country:US
Practice Address - Phone:617-414-4893
Practice Address - Fax:617-414-7212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA102442207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology