Provider Demographics
NPI:1982680674
Name:SULLIVAN, LAWRENCE X JR (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:X
Last Name:SULLIVAN
Suffix:JR
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 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE 156
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-578-3505
Mailing Address - Fax:412-688-7799
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE 156
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-3505
Practice Address - Fax:412-688-7799
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041027E208600000X, 2086S0102X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001141498Medicaid
10937285OtherCAQH
PA0011414980006Medicaid
PA033679NKSMedicare PIN
PA033679PNLMedicare PIN
OH1000099Medicaid