Sullivan, Laura J

Sullivan, Laura J is an individual health care provider with primary practice located at 195 Canal St , Malden MA 02148-6701. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Sullivan, Laura J can be contacted via phone (781) 338-0500.

Contact Information

Primary practice address
195 Canal St Malden MA 02148-6701
Phone: (781) 338-0500
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 213178 Massachusetts

Profile Details

NPI number 1003981705
LBN Legal business name Sullivan, Laura J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 21st, 2006
Last updated Dec 5th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003981705 NPPES
Massachusetts MEDICAID 2108836

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