Individual
DR. CHARLES W SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
98 SECOND ST, HALLOWELL, ME 04347-1368
(207) 649-2795
(617) 488-2237
Mailing address
98 SECOND ST, HALLOWELL, ME 04347-1368
(207) 649-2795
(617) 488-2237
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
1048
ME
207Q00000X
Family Medicine Physician
1048
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015219
PTAN
—
01
—
015555
BCBS
—
05
—
211750000
—
ME
Enumeration date
12/04/2006
Last updated
07/19/2013
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