Active NPI
Mary Anna Sullivan, MD
- Psychiatry Physician
- Burlington, MA
National Provider Identifier
1295759249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 49220
- Practice address
- Lahey Clinic
41 Mall Road
Burlington, MA 01805-0001 - Phone
- (781) 744-8869
- NPI assigned
- Jul 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 49220 | MA | Primary |
Addresses
Primary practice location
Lahey Clinic
41 Mall Road
Burlington, MA 01805-0001
Mailing address
Lahey Clinic
41 Mall Road
Burlington, MA 01805-0001
Phone (781) 744-8869
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3003582 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289865600000",
"number": "1295759249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "LAHEY CLINIC",
"address_2": "41 MALL ROAD",
"city": "BURLINGTON",
"state": "MA",
"postal_code": "018050001",
"telephone_number": "781-744-8869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "LAHEY CLINIC",
"address_2": "41 MALL ROAD",
"city": "BURLINGTON",
"state": "MA",
"postal_code": "018050001",
"telephone_number": "781-744-8869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MARY ANNA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-26",
"last_updated": "2010-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "49220",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3003582",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.