Individual
TIMOTHY M SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 RANDOLPH RD, STE 900, CHARLOTTE, NC 28207-1122
(704) 377-2424
(704) 377-2687
Mailing address
1900 RANDOLPH RD, STE 900, CHARLOTTE, NC 28207-1122
(704) 377-2424
(704) 377-2687
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
9900691
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891225H
—
NC
05
—
N00692
—
SC
Enumeration date
07/14/2006
Last updated
01/11/2010
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