Provider Demographics
NPI:1912934126
Name:SULLIVAN, BARBARA D (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:D
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MARSHALL ST
Mailing Address - Street 2:STE 400
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1687
Mailing Address - Country:US
Mailing Address - Phone:601-354-0869
Mailing Address - Fax:601-352-6521
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:STE 400
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1687
Practice Address - Country:US
Practice Address - Phone:601-354-0869
Practice Address - Fax:601-352-6521
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13522207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0116508Medicaid
MS160000310Medicare PIN
BD3710147Medicare UPIN
MS0116508Medicaid