Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD041868L | PA |
NPI | 1144216938 |
---|---|
Provider Name | Dr. Theodore Robert Sullivan |
First Address | Abington, PA 19001-3714 |
Second Address | Abington, PA 19001-3714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 16/06/2010 |