Individual
SCOTT A. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD.
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-4001
(703) 776-7113
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
0101273019
VA
207V00000X
Obstetrics & Gynecology Physician
23966
SC
207VG0400X
Gynecology Physician
23966
SC
207VM0101X
Maternal & Fetal Medicine Physician
Primary
0101273019
VA
207VM0101X
Maternal & Fetal Medicine Physician
23966
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3922
USC MEDICARE GROUP
SC
05
—
T83022
—
SC
05
—
USC001
—
SC
Enumeration date
08/21/2006
Last updated
12/07/2022
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