Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD050758L | PA |
Y | 2080P0201X | Pediatric Allergist | MD050758L | PA |
N | 2080P0216X | Pediatric Rheumatologist | MD050758L | PA |
NPI | 1831106863 |
---|---|
Provider Name | Kathleen E Sullivan |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-3365 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 30/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001431101 | (05) | PA |
5617308 | (05) | NJ |
F66425 | (02) |