Individual
MITCHELL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
195 INDUSTRIAL PKWY, LYNDONVILLE, VT 05851-4511
(802) 748-9501
(802) 748-3420
Mailing address
PO BOX 83, LYNDONVILLE, VT 05851-0083
(802) 748-9501
(802) 748-3420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042-0012982
VT
207Q00000X
Family Medicine Physician
9367
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0106084YPNH01
ANTHEM BC/BS
NH
01
—
160094
CIGNA HEALTHCARE
NH
05
—
30008999
—
NH
05
—
3073723
—
NH
01
—
5830418
AETNA GROUP
—
01
—
930044719
RAILROAD MEDICARE
—
01
—
9367
STATE LICENSE #
NH
Enumeration date
08/12/2005
Last updated
03/07/2023
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