Provider Demographics
NPI:1568466324
Name:SULLIVAN, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 MLK JR BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:508-757-1589
Mailing Address - Fax:508-756-5633
Practice Address - Street 1:100 MLK JR BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-757-1589
Practice Address - Fax:508-756-5633
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-09-03
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Provider Licenses
StateLicense IDTaxonomies
MA57446207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0200248OtherUNITED HEALTH CARE
MA057446OtherTUFTS HEALTHPLAN
MAJ30252OtherBLUE CROSS BLUE SHIELD
MA985163OtherNETWORK HEALTH
MA6189768Medicaid
MA042923137OtherTAX ID GROUP NUMBER
MA645387OtherHARVARD PILGRIM
MA2376607OtherAETNA HEALTHCARE
MA26920OtherCHILDREN'S MEDICAL SECURI
MA63777OtherFALLON HEALTH PLAN
MA0029830OtherNEIGHBORHOOD HEALTH PLAN
MA326051OtherCIGNA HEALTHCARE
MA645387OtherHARVARD PILGRIM
MA326051OtherCIGNA HEALTHCARE