Individual
MATTHEW PATRICK SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28547-2538
(910) 450-4159
(910) 450-4194
Mailing address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28547-2538
(910) 450-4159
(910) 450-4194
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
200100611
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8912937
—
NC
Enumeration date
04/10/2006
Last updated
01/28/2013
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