Individual
KEVIN M SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 ROCKLAND RD, WILMINGTON, DE 19803-3607
(302) 651-4200
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(407) 650-7129
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
C10008056
DE
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
MD433723
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C10008056
MEDICAL LICENSE
DE
Enumeration date
10/04/2006
Last updated
11/15/2012
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