# KEVIN SULLIVAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1952303463
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 156166 | MA | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 156166 | MA | — |

## Other

- **Enumeration date:** 08/15/2005
- **Last updated:** 11/07/2024