Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0102204769 | VA |
N | 2081P2900X | Pain Medicine | H0053418 | MD |
NPI | 1306866785 |
---|---|
Provider Name | Daniel Sullivan |
First Address | Fishersville, VA 22939-0388 |
Second Address | Fishersville, VA 22939-2273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
325601400 | (05) | MD |
68576206 | BLUE SHIELD TRADITIONAL (01) | MD |
G36923 | (02) | |
P00297124 | RR MEDICARE (01) | |
W2660010 | MD BLUE SHIELD REGIONAL (01) | MD |