Individual
WENDY S. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
6820 HOSPITAL DR, SUITE 210, BALTIMORE, MD 21237-4352
(410) 391-6131
(410) 391-6144
Mailing address
25 CROSSROADS DR, SUITE 306, OWINGS MILLS, MD 21117-5421
(443) 738-2872
(443) 738-2713
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110 002181
VA
363A00000X
Physician Assistant
C0002516
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010234085
—
VA
01
—
541203530
TAS IDENTIFICATION NUMBER
VA
Enumeration date
04/24/2006
Last updated
11/01/2012
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