Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 23966 | SC |
N | 207VG0400X | Gynecologist | 23966 | SC |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 0101273019 | VA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 23966 | SC |
NPI | 1356457717 |
---|---|
Provider Name | Scott A. Sullivan |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 27/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3922 | USC MEDICARE GROUP (01) | SC |
H28033 | (02) | SC |
T83022 | (05) | SC |
USC001 | (05) | SC |