Individual
JONATHON C. SULLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2601 STAFFORD AVENUE, SCRANTON, PA 18505-0305
(570) 346-6633
Mailing address
2601 STAFFORD AVENUE, PO BOX 3305, SCRANTON, PA 18505-0305
(570) 346-6633
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
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