Basic Information
| Provider Information | |||||||||
| NPI: | 1972535599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | FRANCIS | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 LODER ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HORNELL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148431950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073242340 | ||||||||
| FaxNumber: | 6073241697 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 LODER ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HORNELL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148431950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073242340 | ||||||||
| FaxNumber: | 6073241697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 11/01/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | D0037347 | MD | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | MD32909 | DC | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 637126008 | 01 | MD | CIGNA | OTHER | 011444700 | 05 | DC | MEDICAID | 925345 | 01 | MD | AETNA HMO | OTHER | 5931012 | 01 | MD | AETNA PPO/POS | OTHER | 227987 | 01 | MD | MAMSI | OTHER | 241665 | 01 | MD | PHCS | OTHER | 525161300 | 05 | MD | MEDICAID | 603327-02 | 01 | MD | CAREFIRST BC/BS | OTHER | 5473912 | 01 | MD | FIRST HEALTH/CCN | OTHER | 103688 | 01 | MD | KAISER PERMANENTE | OTHER | 29020001 | 01 | DC | CAREFIRST BC/BS | OTHER | 498267 | 01 | DC | NATIONAL CAPITOL PPO | OTHER | 58607 | 01 | MD | AMERIGROUP | OTHER | 176627907 | 01 | MD | UNITED HC/AMERICHOICE | OTHER | 3449 | 01 | MD | JOHNS HOPKINS HEALTHCARE | OTHER |