Individual
DR. MATTHEW DUTTON SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
87 PAINE MOUNTAIN DR, GREEN MOUNTAIN FAMILY PRACTICE, NORTHFIELD, VT 05663-5791
(802) 485-4161
(802) 485-4163
Mailing address
PO BOX 547, ATT: CVMC FINANCE DEPT, BARRE, VT 05641-0547
(802) 485-4161
(802) 485-4163
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042.0013288
VT
207Q00000X
Family Medicine Physician
ML 60107751
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ML 60107751
PHYSICIAN AND SURGEON RESIDENCY LICENSE
WA
Enumeration date
10/28/2009
Last updated
10/09/2015
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