Paul Ryan Charles Sullivan, MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

013428 Issued in CT

Practice address

1093 Prospect Ave
West Hartford, CT 06105-1104

Phone

(860) 523-5753

NPI assigned

Jul 20, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468972800000",
    "number": "1952754400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1093 PROSPECT AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061051104",
            "telephone_number": "860-523-5753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1093 PROSPECT AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061051104",
            "telephone_number": "860-523-5753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "PAUL",
        "middle_name": "RYAN CHARLES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-20",
        "last_updated": "2016-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CT",
            "license": "013428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Kate Sullivan
• Emily Sullivan
• Emily Ricker Sullivan, M ED., BCBA
• Sullivan, Lemay & Associates Behavioral Health & Wellness LLC
• Melinda Jean Sullivan, LCSW LADC
• Paul S Sullivan, D.O.
• Summit Wellness Counseling LLC
• Daniel Kenneth Sunderland, DO
• Susan Bernstein, LCSW, Licsw, LLC
• Ronald T. Suski, MD

• Endocrinology, Diabetes & Metabolism Physician in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Endocrinology, Diabetes & Metabolism Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.