Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 150316 | MA |
N | 111NI0900X | Internist | 150316 | MA |
Y | 207RH0002X | Hospice and Palliative Medicine | 150316 | MA |
NPI | 1184682338 |
---|---|
Provider Name | Elana Sullivan |
First Address | Weymouth, MA 02190-2432 |
Second Address | Weymouth, MA 02190-2432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3192423 | (05) | MA |
G07225 | (02) | MA |