Individual
GAIL T SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9331 OLD BUSTLETON AVE, SUITE 203, PHILADELPHIA, PA 19115-4204
(215) 602-8900
(215) 602-8904
Mailing address
PO BOX 820933, PHILADELPHIA, PA 19182-0933
(215) 602-8900
(215) 602-8904
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
MD054949L
PA
207VG0400X
Gynecology Physician
Primary
MD-054949-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001534913
—
PA
01
—
1007278000
TPI MEDICAID GROUP
PA
01
—
597586
TPI GROUP MEDICARE
PA
01
—
CD4829
TPI RAILROAD MEDICARE
PA
Enumeration date
08/01/2006
Last updated
10/23/2013
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