Organization
PROGRESSIVE WOMEN OB-GYN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGINA T SULLIVAN M.D.,FACOG (COO)
(610) 330-3333
Entity
Organization
Contact information
Practice address
301 S 22ND ST, EASTON, PA 18042-3811
(610) 330-3333
Mailing address
301 S 22ND ST, EASTON, PA 18042-3811
(610) 330-3333
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD068031L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA67679
STATE MD LICENSE
NJ
01
—
MD068031L
MD LICENSE
PA
Enumeration date
02/01/2007
Last updated
08/22/2020
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