Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | D0050954 | MD |
NPI | 1013915883 |
---|---|
Provider Name | Dr. Brian J Sullivan |
First Address | Annapolis, MD 21401-3371 |
Second Address | Annapolis, MD 21401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 26/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
352303900 | (05) | MD |
3550284 | AETNA (01) | |
471782 | MAMSI (01) | |
487760200 | FEDERAL WORKMANS COMP (01) | |
76918803 | BCBS (01) | |
76918804 | BCBS (01) | |
76918806 | BCBS (01) | MD |
76918807 | BCBS (01) | MD |
D3800006 | BCBS (01) | DC |
H31202 | (02) | MD |
J4570002 | BCBS (01) | DC |
W8490002 | BCBS (01) | DC |