Provider Demographics
NPI:1013915883
Name:SULLIVAN, BRIAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 BESTGATE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3371
Mailing Address - Country:US
Mailing Address - Phone:410-266-2720
Mailing Address - Fax:410-224-0209
Practice Address - Street 1:1000 BESTGATE RD STE 400
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-2720
Practice Address - Fax:410-244-0209
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050954207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
76918803OtherBCBS
DCW8490002OtherBCBS
3550284OtherAETNA
MD76918806OtherBCBS
471782OtherMAMSI
MD352303900Medicaid
76918804OtherBCBS
MD76918807OtherBCBS
487760200OtherFEDERAL WORKMANS COMP
DCJ4570002OtherBCBS
DCD3800006OtherBCBS
MD76918807OtherBCBS
P00332694Medicare PIN
MDH31202Medicare UPIN
DCJ4570002OtherBCBS
487760200OtherFEDERAL WORKMANS COMP