DR. JOHN L SULLIVAN (NPI# 1821072547) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821072547 |
| Entity Type | Individual |
| Full Name | DR. JOHN L SULLIVAN |
| Credential | M.D. |
| Practice Address |
55 Lake Ave N Department of Pediatric Allergy & Immunology Worcester MA 01655-0002 |
| Mailing Address |
Po Box 415348 Boston MA 02241-0001 |
| Practice Telephone | 5088561572 |
| Practice Fax Number | 5088565004 |
| Mailing Telephone | 8002258885 |
| Mailing Fax Number | 5083341977 |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2020-11-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0201X |
Pediatrics Specialization: Pediatric Allergy/Immunology |
42650 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 2061902 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639789027 | John Sullivan | Counselor | 1104 Cavalier Dr, Waukesha, WI 53186-6883 | 2020-07-31 |
| 1659820454 | John Christopher Sullivan | Counselor | 413 N Bridge St, Dewitt, MI 48820-8907 | 2016-09-22 |
| 1538576764 | John Michael Sullivan | Psychologist | One Old Oyster Point Road, Newport News, VA 23602 | 2014-07-21 |
| 1962827808 | John Sullivan | Emergency Medicine | 92 Wood Cove Dr, Coventry, RI 02816-6614 | 2014-03-02 |
| 1225368145 | John Patrick Sullivan Jr. | Psychologist | 8 Bradford Ave, Newport, RI 02840-2202 | 2009-12-29 |
| 1679703425 | John Michael Sullivan | Dentist | 9770 Old Baymeadows Rd Ste 113, Jacksonville, FL 32256-7986 | 2009-07-14 |
| 1649484726 | John F Sullivan | Pharmacist | 44 Timber Ln, Methuen, MA 01844-4644 | 2007-05-09 |
| 1881812410 | John Michael Sullivan | Social Worker | 735 Requa St, Peekskill, NY 10566-4615 | 2007-04-20 |
| 1114049228 | John M Sullivan | Chiropractor | 3945 Us Highway 77, Corpus Christi, TX 78410-4531 | 2007-04-06 |
| 1457412306 | John J Sullivan | Dentist | 325 W White Mountain Blvd, Lakeside, AZ 85929-6875 | 2006-12-13 |
| Street Address |
55 LAKE AVE N DEPARTMENT OF PEDIATRIC ALLERGY & IMMUNOLOGY |
| City | WORCESTER |
| State | MA |
| Zip Code | 01655-0002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477556587 | James E Liebmann | Internal Medicine | 55 Lake Ave N, Hematology/oncology, Worcester, MA 01655-0002 | 2005-05-23 |
| 1518568732 | Justin Bullard | Psychologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-11-04 |
| 1346849825 | Meghan Moore | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-26 |
| 1174122899 | Jessica Goncalves Ferreira | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-23 |
| 1235746686 | Desiree Mytych | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-29 |
| 1659986248 | Rebecca Lynn Harris | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-10 |
| 1639781487 | Gabriella Kathleen Holland | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-21 |
| 1730791898 | Kerry Anne Benedict | Speech-Language Pathologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
| 1902418999 | Natasha R. Turner | Genetic Counselor, MS | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
| 1144830712 | Abbey Corsini | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205489713 | Darryl Sweeper Jr. | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Psychiatry, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-23 |
| 1225690530 | Ryan Zenevitch | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Family Medicine, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-08 |
| 1932688454 | Victoria Sayeg | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Pediatrics, Worcester, MA 01655 | 2018-08-07 |
| 1114425675 | Judith Dio Wentzell | Social Worker | Umassmemorial Medical Center, 55 Lake Ave North, Dept of Care Coordination, Worcester, MA 01655 | 2018-01-30 |
| 1861927386 | Muhammad Waqas Khan | Student in an Organized Health Care Education/Training Program | University of Massachusetts 55 North Lake Ave, Neurology, Worcester, MA 01655 | 2017-04-21 |
| 1861806192 | Qaiser Shamshir Khan | Psychiatry & Neurology | 55 Lake Ave N # S7-831, Worcester, MA 01655 | 2014-06-14 |
| 1073858981 | Heidi Glover | Nurse Practitioner | 55 Lake Ave North Dept. of Pedi-adolescent, Ummc University Campus, Worcester, MA 01655 | 2012-12-04 |
| 1972867992 | Anna Bjornsdottir | Psychiatry & Neurology | 55 Lake Av N, Worcester, MA 01655 | 2012-06-25 |
| 1245567676 | Steven Edward Mckinley | Nurse Practitioner | 55 Lake Ave. North, Umass Memorial Medical Center University Campus, Worcester, MA 01655 | 2009-11-05 |
| 1851582951 | Robin I Davidson | Neurological Surgery | 55 Lake Ave, North, Ummhc-univ Campus, Worcester, MA 01655 | 2007-08-05 |
| Find all providers in zip 01655 | ||||
| Taxonomy Code | 2080P0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Allergy/Immunology |
| A pediatrician who specializes in the diagnosis and treatment of allergies, allergic reactions, and immunologic diseases in children. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: title modified, definition added, source added] Additional Resources: A Certification of Special Qualifications (CSQ) is issued by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437153376 | Nathan Alan Harris | Pediatrics | 100 Mlk Jr Blvd, 2nd Floor, Worcester, MA 01608-1209 | 2005-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083684955 | Thomas F Plaut | Pediatrics | 125 Red Gate Ln, Amherst, MA 01002-1844 | 2006-01-24 |
| 1376177790 | Greater Boston Allergy Asthma Sinus & Immunology Centers, P.C. | Pediatrics | 244 Willow St, Yarmouth Port, MA 02675-1757 | 2020-02-25 |
| 1841533569 | Chen E Rosenberg | Pediatrics | 55 Fruit St, Boston, MA 02114-2696 | 2013-04-01 |
| 1972894988 | Brittany Elizabeth Esty | Pediatrics | 300 Longwood Ave, Boston, MA 02115 | 2011-04-25 |
| 1528227303 | Susan A. Rudders | Pediatrics | 300 Longwood Ave, Boston, MA 02115-5724 | 2008-06-05 |
| 1093984064 | Luigi Notarangelo | Pediatrics | 300 Longwood Ave, Fegan 6, Boston, MA 02115-5724 | 2008-02-25 |
| 1346330446 | Ana D Broyles | Pediatrics | 300 Longwood Ave, Boston, MA 02115-5724 | 2006-10-13 |
| 1104916204 | Dale T Umetsu | Pediatrics | 300 Longwood Ave, Boston, MA 02115-5724 | 2006-10-13 |
| 1427148535 | Robert P Sundel | Pediatrics | 300 Longwood Ave, Boston, MA 02115-5724 | 2006-10-13 |
| 1568488161 | Michele J. Gottlieb | Pediatrics | 24 Newton St, Southborough, MA 01772-1215 | 2006-07-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.