Individual
CHRISTOPHER ALBERT SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-9440
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-9440
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
200500610
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10157978
—
VA
01
—
139F4
BCBS
—
01
—
182602
MEDCOST
—
05
—
3810001904
—
WV
05
—
5900684
—
NC
01
—
7184757
AETNA
—
01
—
805849
PARTNERS
—
01
—
P00404443
RR MEDICARE
—
Enumeration date
11/30/2005
Last updated
08/23/2010
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