Individual
RICHARD L SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
49 SPRING ST, SCARBOROUGH, ME 04074-8926
(207) 883-1414
(207) 883-1518
Mailing address
39 WALLACE AVE, SOUTH PORTLAND, ME 04106-6143
(207) 761-0650
(207) 761-8198
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
008530
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26977009
—
ME
05
—
292100099
—
ME
05
—
30209412
—
NH
Enumeration date
07/29/2005
Last updated
12/01/2014
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