Provider Demographics
NPI:1760500193
Name:SULLIVAN, CHRISTOPHER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:SULLIVAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1906 BELLEVIEW AVE SE
Mailing Address - Street 2:CARILION CLINIC DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1838
Mailing Address - Country:US
Mailing Address - Phone:540-981-2987
Mailing Address - Fax:540-344-5280
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:CARILION CLINIC DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-981-2987
Practice Address - Fax:540-344-5280
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-12-11
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Provider Licenses
StateLicense IDTaxonomies
VA0101255143207V00000X
VT042-0011548207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology