Provider Demographics
NPI:1831114545
Name:SULLIVAN, RICHARD PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PATRICK
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13566
Mailing Address - Street 2:EMERGENCY PHYSICIANS OF PITTSBURGH LTD
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:565 COAL VALLEY ROAD
Practice Address - Street 2:JEFFERSON REGIONAL MEDICAL CENTER
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236
Practice Address - Country:US
Practice Address - Phone:412-469-5959
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052040L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001444173Medicaid
PA001444173Medicaid
PA193964Medicare ID - Type Unspecified