Basic Information
| Provider Information | |||||||||
| NPI: | 1083680136 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 BLAIR MILL RD STE C | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154430660 | ||||||||
| FaxNumber: | 2154438422 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 BLAIR MILL RD STE C | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154430660 | ||||||||
| FaxNumber: | 2154438422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 02/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD023291E | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.