Provider Demographics
NPI:1023422748
Name:SULLIVAN, JAMES COOPER (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:COOPER
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:696 DANIEL WEBSTER HWY
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-2748
Mailing Address - Country:US
Mailing Address - Phone:603-429-3155
Mailing Address - Fax:603-424-8693
Practice Address - Street 1:696 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-2748
Practice Address - Country:US
Practice Address - Phone:603-429-3155
Practice Address - Fax:603-672-7150
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18598204D00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM