Provider Demographics
NPI:1750543294
Name:SULLIVAN, RACHEL M (MD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE RD, TRIPLER ARMY MEDICAL CENTER
Mailing Address - Street 2:ATTN: MCHK-BH, CAFBHS
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96859-0000
Mailing Address - Country:US
Mailing Address - Phone:808-433-6418
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD, TRIPLER ARMY MEDICAL CENTER
Practice Address - Street 2:ATTN: MCHK-BH, CAFBHS
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96859-0000
Practice Address - Country:US
Practice Address - Phone:808-433-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE254212084P0800X, 2084P0804X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN