Provider Demographics
NPI:1699432575
Name:SULLIVAN, RICHARD LOUIS
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LOUIS
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 W ST SE APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-8124
Mailing Address - Country:US
Mailing Address - Phone:202-848-0463
Mailing Address - Fax:
Practice Address - Street 1:21 ATLANTIC ST SW APT 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2353
Practice Address - Country:US
Practice Address - Phone:202-758-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant