Individual
MR. THOMAS BRIAN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
790 BRYAN ST, HUNTINGDON, PA 16652-2410
(814) 643-8299
(814) 643-8300
Mailing address
4133 MEDICAL CENTER DR, BROAD TOP, PA 16621-9001
(814) 635-2916
(814) 635-2918
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0A002066
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103205926
—
PA
01
—
376731WFP
MEDICARE
—
Enumeration date
07/24/2006
Last updated
06/06/2024
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