Individual
MARK C SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
333 BORTHWICK AVENUE, SUITE 402, PORTSMOUTH, NH 03801
(603) 559-4111
(603) 663-6822
Mailing address
333 BORTHWICK AVENUE, SUITE 402, PORTSMOUTH, NH 03801
(603) 559-4111
(603) 559-4110
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0238P
NH
363AS0400X
Surgical Physician Assistant
PA 880
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3076816
—
NH
Enumeration date
05/31/2006
Last updated
10/04/2023
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