Provider Demographics
NPI:1023236494
Name:SULLIVAN, RACHEL AILEEN (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:AILEEN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PLAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3241
Mailing Address - Country:US
Mailing Address - Phone:401-649-4901
Mailing Address - Fax:401-649-4903
Practice Address - Street 1:235 PLAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3241
Practice Address - Country:US
Practice Address - Phone:401-649-4901
Practice Address - Fax:401-649-4903
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13340208200000X
MA245997208200000X
MDD0069074208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery