Individual
DR. PAMELA J SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 MEDICAL CENTER DRIVE, CLARKSBURG, WV 26301-4199
(304) 623-3461
(304) 623-7666
Mailing address
1 MEDICAL CENTER DRIVE, CLARKSBURG, WV 26301-4199
(304) 623-3461
(302) 623-7666
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
12090
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0116952000
—
WV
01
—
260024338
RAILROAD MEDICARE
WV
Enumeration date
02/09/2006
Last updated
04/10/2012
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