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Individual

BENJAMIN ALEXANDER SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.-C

Contact information

Practice address
900 CATON AVENUE, BALTIMORE, MD 21229
(410) 368-2514
(410) 368-2640
Mailing address
P.O. BOX 21182, BALTIMORE, MD 21228
(410) 368-8640
(410) 368-8644

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0003370
MD

Other

Enumeration date
12/05/2006
Last updated
07/08/2007
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