Provider Demographics
NPI:1780679472
Name:SULLIVAN, JAMES FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRANCIS
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 SANDY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1720
Mailing Address - Country:US
Mailing Address - Phone:860-572-8911
Mailing Address - Fax:860-572-7758
Practice Address - Street 1:200 SANDY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1720
Practice Address - Country:US
Practice Address - Phone:860-572-8911
Practice Address - Fax:860-572-7758
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT017250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD33504Medicare UPIN
CT490000057Medicare PIN