Doctor Name: | DR. ROBERT EDWIN O' SULLIVAN |
NPI Number: | 1053751271 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 267 Grant Street Bridgeport, CT - 06610 |
Business Phone Number: | 2033843446 |
Business Fax Number: | |
Mailing Address: | 185 Canal Street East, Unit 1075 SHELTON |
State: | CT |
Postal Code: | 06484 |
Phone Number: | 2038921170 |
Fax Number: | |
NPI Enumeration Date: | 07/02/2013 |
NPI Last Update Date: | 07/02/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |