Individual
JOHN K SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
49 SPRING ST, 2ND FLOOR, SCARBOROUGH, ME 04074-8926
(207) 883-1414
(207) 883-1518
Mailing address
301C US ROUTE 1, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD10681
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290400099
—
ME
05
—
30004047
—
NH
Enumeration date
07/28/2005
Last updated
10/23/2012
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