Provider Demographics
NPI:1427113760
Name:SULLIVAN, MATTHEW FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:FRANCIS
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 1:825 WASHINGTON ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3441
Mailing Address - Country:US
Mailing Address - Phone:781-762-0311
Mailing Address - Fax:781-762-0634
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:SUITE 340
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-762-0311
Practice Address - Fax:781-762-0634
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188392207R00000X
MA239645207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine