Organization
ROBERT W SULLIVAN DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT WALTER SULLIVAN D.P.M. (PRESIDENT)
(757) 363-3338
Entity
Organization
Contact information
Practice address
1700 PLEASURE HOUSE RD, SUITE 101-102, VIRGINIA BEACH, VA 23455-4053
(757) 363-3338
(757) 363-3453
Mailing address
1700 PLEASURE HOUSE RD, SUITE 101-102, VIRGINIA BEACH, VA 23455-4053
(757) 363-3338
(757) 363-3453
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0103000735
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480026957
RR MEDICARE
VA
01
—
571322
OPTIMA
VA
Enumeration date
08/11/2006
Last updated
07/29/2021
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