Provider Demographics
NPI:1881621720
Name:SULLIVAN, ANDREW L (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5552
Mailing Address - Country:US
Mailing Address - Phone:215-493-5535
Mailing Address - Fax:215-493-0810
Practice Address - Street 1:777 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5552
Practice Address - Country:US
Practice Address - Phone:215-493-5535
Practice Address - Fax:215-493-0810
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD420888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019456230001Medicaid
H82794Medicare UPIN
PA0019456230001Medicaid