Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 9701609 | NC |
NPI | 1003840497 |
---|---|
Provider Name | David Sullivan |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28203-5812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H21389 | (02) | NC |