# MARK T SULLIVAN

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1952393514
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 205 | MT | Yes |

## Other

- **Enumeration date:** 08/19/2005
- **Last updated:** 04/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000900883 | BLUECROSS BLUESHIELD | MT |
| 05 | — | 119184500 | — | WY |
| 05 | — | 435438 | — | MT |
| 01 | — | 970010277 | RR MEDICARE | MT |