Individual
ROSS WILLIAM SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-4363
(315) 464-8690
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-4363
(315) 464-8690
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
258893
NY
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
258893
NY
207RA0401X
Addiction Medicine (Internal Medicine) Physician
258893
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03302994
—
NY
Enumeration date
08/20/2008
Last updated
04/05/2017
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