Provider Demographics
NPI:1245233568
Name:SULLIVAN, WILLIAM D (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:751 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2559
Mailing Address - Country:US
Mailing Address - Phone:814-724-8346
Mailing Address - Fax:814-336-6256
Practice Address - Street 1:751 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2559
Practice Address - Country:US
Practice Address - Phone:814-724-8346
Practice Address - Fax:814-336-6256
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2014-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027451E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008745270001Medicaid
PA251754199OtherMEDICAL MUTUAL OF OHIO
PA4235190002OtherNATIONAL SUPPLIERS CLEARINGHOUSE
PAC30051OtherHEALTH AMERICA
PA020102200OtherBLACK LUNG PROGRAM
PA0650611Medicaid
PA82392OtherUNISON HEALTH PLAN
PA290007406OtherPALMETTO GBA-RAILROAD MEDICARE
PA205046OtherUPMC HEALTH PLAN
PA902561OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA82392OtherUNISON HEALTH PLAN
PA4235190002OtherNATIONAL SUPPLIERS CLEARINGHOUSE