Individual
JERRY J. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6501 LOISDALE CT, SPRINGFIELD, VA 22150-1826
(703) 922-1000
(703) 922-1039
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101243402
VA
207Q00000X
Family Medicine Physician
D0071387
MD
207Q00000X
Family Medicine Physician
MD00017070
WA
207Q00000X
Family Medicine Physician
MD039385
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8103087
—
WA
Enumeration date
01/17/2007
Last updated
11/22/2011
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