Provider Demographics
NPI:1073657003
Name:O'SULLIVAN, AOIFE (MD)
Entity type:Individual
Prefix:DR
First Name:AOIFE
Middle Name:
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 NE 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2402
Mailing Address - Country:US
Mailing Address - Phone:410-409-6574
Mailing Address - Fax:
Practice Address - Street 1:9555 SW BARNES RD STE 255
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6654
Practice Address - Country:US
Practice Address - Phone:503-908-1590
Practice Address - Fax:503-723-2862
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD174903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00433444OtherRAILROAD
MD413344700Medicaid
MD613LR353OtherMEDICARE
MD451601000Medicaid
MD413344700Medicaid
MD613LR353Medicare PIN