Individual
DR. MATTHEW PATRICK SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6620 FLY RD, STE 200, EAST SYRACUSE, NY 13057-9791
(315) 464-4472
Mailing address
6620 FLY RD, STE 200, EAST SYRACUSE, NY 13057-9791
(315) 464-4472
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
MD60545599
WA
207XX0801X
Orthopaedic Trauma Physician
Primary
MD60545599
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04488400
—
NY
Enumeration date
05/12/2010
Last updated
11/02/2016
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