Provider Demographics
NPI:1487947669
Name:DEMARTINO, ERIN SULLIVAN (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:SULLIVAN
Last Name:DEMARTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:MAYO CLINIC
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-1000
Mailing Address - Country:US
Mailing Address - Phone:507-284-2416
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:MAYO CLINIC
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-1000
Practice Address - Country:US
Practice Address - Phone:507-284-2416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN57477207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program