1972535599 NPI number — FRANCIS JOHN SULLIVAN M.D.

Table of content: FRANCIS JOHN SULLIVAN M.D. (NPI 1972535599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972535599 NPI number — FRANCIS JOHN SULLIVAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
FRANCIS
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972535599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 LODER ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
HORNELL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14843-1950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-324-2340
Provider Business Mailing Address Fax Number:
607-324-1697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 LODER ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HORNELL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14843-1950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-324-2340
Provider Business Practice Location Address Fax Number:
607-324-1697
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  D0037347 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0001X , with the licence number: MD32909 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 637126008 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 011444700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 925345 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5931012 . This is a "AETNA PPO/POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 227987 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 241665 . This is a "PHCS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 525161300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 603327-02 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5473912 . This is a "FIRST HEALTH/CCN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 103688 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 29020001 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 498267 . This is a "NATIONAL CAPITOL PPO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 58607 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 176627907 . This is a "UNITED HC/AMERICHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3449 . This is a "JOHNS HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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