Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 16770 | NH |
N | 2080P0214X | Pediatric Pulmonologist | 52083 | MA |
NPI | 1306820014 |
---|---|
Provider Name | Dr. Brian P O'sullivan |
First Address | Bedford, NH 03110-6736 |
Second Address | Bedford, NH 03110-6736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 26/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6175368 | (05) | MA |
E01830 | (02) | MA |