Provider Demographics
NPI:1730161308
Name:SULLIVAN, JAMES J (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:60 HOSPITAL RD WACHUSETT EMERGENCY PHYSICIANS PC
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-466-2580
Mailing Address - Fax:978-466-2993
Practice Address - Street 1:60 HOSPITAL RD
Practice Address - Street 2:UMASS MEMORIAL HEALTH ALLIANCE CLINTON HOSPITAL
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-2451
Practice Address - Fax:978-466-2570
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA202737207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2020734Medicaid
MAH65693Medicare UPIN
MA2020734Medicaid
MAA3428905Medicare PIN