Provider Demographics
NPI:1740633981
Name:PHILIP G SULLIVAN MD
Entity type:Organization
Organization Name:PHILIP G SULLIVAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-759-1482
Mailing Address - Street 1:PO BOX 1034
Mailing Address - Street 2:
Mailing Address - City:MONUMENT BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02553-1034
Mailing Address - Country:US
Mailing Address - Phone:508-759-1482
Mailing Address - Fax:508-743-9202
Practice Address - Street 1:489 SHORE RD
Practice Address - Street 2:
Practice Address - City:MONUMENT BEACH
Practice Address - State:MA
Practice Address - Zip Code:02553-1034
Practice Address - Country:US
Practice Address - Phone:508-759-1482
Practice Address - Fax:508-743-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26061207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty