Provider Demographics
NPI:1639159924
Name:SULLIVAN, JAMES J (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 NORMANDIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408
Mailing Address - Country:US
Mailing Address - Phone:717-650-6690
Mailing Address - Fax:717-650-2703
Practice Address - Street 1:1850 NORMANDIE DRIVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408
Practice Address - Country:US
Practice Address - Phone:717-650-6690
Practice Address - Fax:717-650-2703
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05007411E225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA250007330OtherRAIL ROAD MEDICARE
PA250007330OtherRAIL ROAD MEDICARE
E82822Medicare UPIN