Provider Demographics
NPI:1972687473
Name:SULLIVAN, REGINA T (MD,FACOG)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:T
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD,FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 BELVIDERE RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1778
Mailing Address - Country:US
Mailing Address - Phone:908-859-5308
Mailing Address - Fax:908-859-5251
Practice Address - Street 1:985 BELVIDERE RD
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1778
Practice Address - Country:US
Practice Address - Phone:908-859-5308
Practice Address - Fax:908-859-5251
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67679207VX0000X
PAMD68031L207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7715609Medicaid
NJ012339Medicare ID - Type Unspecified
NJ7715609Medicaid