Sullivan, John L

Sullivan, John L is an individual health care provider with primary practice located at 55 Lake Ave N Department Of Pediatric Allergy & Immunology, Worcester MA 01655-0002. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Allergy/Immunology, which is considered as his primary health care specialty. Sullivan, John L can be contacted via phone (508) 856-1572.

Contact Information

Primary practice address
55 Lake Ave N Department Of Pediatric Allergy & Immunology Worcester MA 01655-0002
Phone: (508) 856-1572
Fax: (508) 856-5004
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Allergy/Immunology 2080P0201X 42650 Massachusetts

Profile Details

NPI number 1821072547
LBN Legal business name Sullivan, John L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 6th, 2005
Last updated Nov 9th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821072547 NPPES
Massachusetts MEDICAID 2061902

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