Individual
JONATHON C. SULLUM
Active
Individual
JONATHON C. SULLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD020198E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000083999
THREE RIVERS
PA
01
—
0004210397
0004210397
PA
05
—
0006585310012
—
PA
01
—
10624 1686
GEISINGER HEALTH PLAN
PA
01
—
141629
HIGHMARK BLUE SHIELD
PA
01
—
20007413
AMERIHEALTH MERCY
PA
01
—
300020246
RAILROAD MEDICARE
PA
01
—
C31604
BLUE CROSS
PA
Enumeration date
08/15/2006
Last updated
07/09/2007
Update your record
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