Individual
JON M. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5371
(740) 446-5711
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5371
(740) 446-5711
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
16987
WV
208000000X
Pediatrics Physician
Primary
35-05-4754
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006810
ANTHEM BCBS
WV
01
—
000000007592
ANTHEM BCBS
—
01
—
000000181879
UNISON MEDICAID #
OH
01
—
001714064
MOUNTAIN STATE BCBS
—
05
—
0107833000
—
WV
01
—
0882719
MOLINA MEDICAID #
OH
05
—
0882719
—
OH
01
—
310917085065
CARESOURCE MEDICAID #
OH
01
—
370002760
RR MEDICARE
OH
Enumeration date
07/03/2006
Last updated
12/29/2020
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