Individual
IRIS SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
64 WHALON STREET, FITCHBURG, MA 01420
(978) 809-0037
(978) 829-0048
Mailing address
64 WHALON STREET, FITCHBURG, MA 01420
(978) 809-0037
(978) 829-0048
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
156837
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3183378
—
MA
Enumeration date
04/25/2006
Last updated
07/09/2009
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