Individual
ROBERT A SULLIVAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2728 OLD FOREST RD, LYNCHBURG, VA 24501-2445
(434) 385-8190
(434) 385-5873
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
0101055474
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982869897
—
VA
01
—
VVT217A
MEDICARE PTAN
VA
Enumeration date
06/09/2006
Last updated
01/13/2025
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