Provider Demographics
NPI:1972535599
Name:SULLIVAN, FRANCIS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:JOHN
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 1:111 LODER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1950
Mailing Address - Country:US
Mailing Address - Phone:607-324-2340
Mailing Address - Fax:607-324-1697
Practice Address - Street 1:111 LODER ST
Practice Address - Street 2:SUITE B
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1950
Practice Address - Country:US
Practice Address - Phone:607-324-2340
Practice Address - Fax:607-324-1697
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00373472085R0001X
DCMD329092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD637126008OtherCIGNA
DC011444700Medicaid
MD925345OtherAETNA HMO
MD5931012OtherAETNA PPO/POS
MD227987OtherMAMSI
MD241665OtherPHCS
MD525161300Medicaid
MD603327-02OtherCAREFIRST BC/BS
MD5473912OtherFIRST HEALTH/CCN
MD103688OtherKAISER PERMANENTE
DC29020001OtherCAREFIRST BC/BS
DC498267OtherNATIONAL CAPITOL PPO
MD58607OtherAMERIGROUP
MD176627907OtherUNITED HC/AMERICHOICE
MD3449OtherJOHNS HOPKINS HEALTHCARE
MD58607OtherAMERIGROUP
E27560Medicare UPIN
MD920005909Medicare PIN