Provider Demographics
NPI:1508556044
Name:SULLIVAN, KARMAN
Entity Type:Individual
Prefix:
First Name:KARMAN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 PARRISH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1534
Mailing Address - Country:US
Mailing Address - Phone:267-622-7819
Mailing Address - Fax:
Practice Address - Street 1:5160 PARRISH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1534
Practice Address - Country:US
Practice Address - Phone:267-622-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA29333269207RI0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory Immunology