Provider Demographics
NPI:1154412906
Name:SULLIVAN, STEPHEN R (MD, MPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:SULLIVAN
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Gender:M
Credentials:MD, MPH
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Other - First Name:
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Mailing Address - Street 1:300 MOUNT AUBURN STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:617-492-0620
Mailing Address - Fax:617-492-0631
Practice Address - Street 1:300 MOUNT AUBURN ST STE 304
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5665
Practice Address - Country:US
Practice Address - Phone:617-492-0620
Practice Address - Fax:617-492-0631
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-08-10
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Provider Licenses
StateLicense IDTaxonomies
MA233018208200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery