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Individual
GINA T SULLIVAN
Active
Individual
GINA T SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
258579
MA
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
258579
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110104869A
—
MA
Enumeration date
05/13/2010
Last updated
11/10/2020
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