Individual
BRENDAN L SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9010 LORTON STATION BLVD, SUITE 100, LORTON, VA 22079-4792
(703) 436-1200
(703) 642-0392
Mailing address
1500 N BEAUREGARD ST, SUITE 200, ALEXANDRIA, VA 22311-1723
(703) 436-1200
(703) 575-9525
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101227543
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6721001
—
VA
Enumeration date
03/18/2006
Last updated
01/28/2011
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