Provider Demographics
NPI:1679679906
Name:SULLIVAN, MOLLY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:27 PARK ST
Mailing Address - Street 2:CAPE COD HOSPITAL/RADIATION ONCOLOGY DEPT.
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5230
Mailing Address - Country:US
Mailing Address - Phone:508-862-5300
Mailing Address - Fax:508-862-7987
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:CAPE COD HOSPITAL/RADIATION ONCOLOGY DEPT.
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5230
Practice Address - Country:US
Practice Address - Phone:508-862-5300
Practice Address - Fax:508-862-7987
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2302002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G17371Medicare UPIN