Individual
MR. MATTHEW DALEY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
830 OAK ST, 125E, BROCKTON, MA 02301-1168
(508) 588-1505
(508) 588-1508
Mailing address
830 OAK ST, 125E, BROCKTON, MA 02301-1168
(508) 588-1505
(508) 588-1508
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1141
MA
Other
Enumeration date
07/12/2005
Last updated
06/26/2008
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