Provider Demographics
NPI:1649286774
Name:SULLIVAN, FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ STE 400
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4760
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:900 WARREN AVE STE 401
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1430
Practice Address - Country:US
Practice Address - Phone:401-330-2480
Practice Address - Fax:401-808-6329
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06223207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7001162Medicaid
RI939025129OtherRI MEDICARE GROUP NUMBER
RI1649286774OtherNPI
MA3190188Medicaid
RI11/12/2009OtherNHPRI
RI04/15/2009OtherUNITED HEALTHCARE
RI7001162Medicaid
RI1649286774OtherNPI
RI939025129OtherRI MEDICARE GROUP NUMBER
RI007004946Medicare ID - Type Unspecified
MA12/29/2008OtherTUFTS HEALTH PLAN