Provider Demographics
NPI:1851396006
Name:DR SULS FAMILY & SPORTS MEDICINE
Entity Type:Organization
Organization Name:DR SULS FAMILY & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SULS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-622-2112
Mailing Address - Street 1:20 WASHINGTON PL STE 3
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6743
Mailing Address - Country:US
Mailing Address - Phone:603-622-2112
Mailing Address - Fax:603-624-1570
Practice Address - Street 1:20 WASHINGTON PL STE 3
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6743
Practice Address - Country:US
Practice Address - Phone:603-622-2112
Practice Address - Fax:603-624-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9753207Q00000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH55970OtherCIGNS VENDER #
NHCK3214OtherRR MEDICARE
NH2567744OtherOXFORD
NH30211159Medicaid
NHM17742OtherBCBS OF MASSACHUSETTS
NHRE6655Medicare ID - Type Unspecified