Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 18598 | NH |
N | 207Q00000X | Family Doctor | 18598 | NH |
NPI | 1023422748 |
---|---|
Provider Name | James Cooper Sullivan |
First Address | Merrimack, NH 03054-2748 |
Second Address | Merrimack, NH 03054-2748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2014 |
Last Update Date | 11/12/2020 |