National Provider Identifier
Thaddeus Joseph Sullivan, DO
Thaddeus Joseph Sullivan, DO is listed in the NPPES registry with a primary specialty of Student in an Organized Health Care Education/Training Program in Elmira, NY and a listed phone number of (607) 442-1713.
Profile Overview
- NPI
- 1063157717
- Provider Type
- Individual
- Primary Specialty
- Student in an Organized Health Care Education/Training Program
- Enumeration Date
- April 27, 2022
- Last Updated
- April 27, 2022
Practice Location
- 600 Roe Ave
- Elmira, NY 14905-1629
Phone: (607) 442-1713
Mailing Address
- 111 Chapel Vw
- Clinton, NY 13323-3958
Specialties
- Student in an Organized Health Care Education/Training Program (390200000X)
Full Record
- NPI
- 1063157717
- Entity Type
- Individual
- Last Name
- Sullivan
- First Name
- Thaddeus
- Middle Name
- Joseph
- Name Prefix
- Dr.
- Credential
- DO
- Mailing Street Address
- 111 Chapel Vw
- Mailing City
- Clinton
- Mailing State
- NY
- Mailing ZIP Code
- 13323-3958
- Mailing Country
- US
- Practice Street Address
- 600 Roe Ave
- Practice City
- Elmira
- Practice State
- NY
- Practice ZIP Code
- 14905-1629
- Practice Country
- US
- Practice Phone
- (607) 442-1713
- Enumeration Date
- April 27, 2022
- Last Updated
- April 27, 2022
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- April 27, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Student in an Organized Health Care Education/Training Program (390200000X)