Individual
THOMAS S SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12018 SUNRISE VALLEY DR, SUITE 400, RESTON, VA 20191-3432
(571) 262-5200
(571) 521-7249
Mailing address
5440 CHANDLEY FARM CIR, CENTREVILLE, VA 20120-1239
(703) 815-1124
(703) 815-7411
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101043001
VA
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
0101043001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010051185
—
VA
Enumeration date
08/01/2006
Last updated
03/21/2011
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