Individual
JON M. SULLIVAN
Active
Individual
JON M. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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