| Mitchell Sullivan, MD | |
|
195 Industrial Pkwy, Lyndonville, VT 05851-4511 | |
| (802) 748-9501 | |
| (802) 748-3420 |
| Full Name | Mitchell Sullivan |
|---|---|
| Gender | Male |
| Speciality | Family Practice |
| Experience | 34 Years |
| Location | 195 Industrial Pkwy, Lyndonville, Vermont |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841292562 | NPI | - | NPPES |
| 160094 | Other | NH | CIGNA HEALTHCARE |
| 0106084YPNH01 | Other | NH | ANTHEM BC/BS |
| 5830418 | Other | AETNA GROUP | |
| 9367 | Other | NH | STATE LICENSE # |
| 30008999 | Medicaid | NH | |
| 930044719 | Other | RAILROAD MEDICARE | |
| 3073723 | Medicaid | NH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 9367 (New Hampshire) | Secondary |
| 207Q00000X | Family Medicine | 042-0012982 (Vermont) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Caledonia Home Health Care | Saint johnsbury, VT | Home health agency |
| North Country Home Health & Hospice Agency | Littleton, NH | Home health agency |
| Northeastern Vermont Regional Hospital | Saint johnsbury, VT | Hospital |
| Androscoggin Valley Hospital | Berlin, NH | Hospital |
| Mary Hitchcock Memorial Hospital | Lebanon, NH | Hospital |
| Central Vermont Medical Center | Barre, VT | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Northeastern Vermont Regional Hospital Inc | 3678481405 | 107 |
| Entity Name | Northeastern Vermont Regional Hospital Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659459428 PECOS PAC ID: 3678481405 Enrollment ID: O20080208000261 |
| Mailing Address | Practice Location Address |
|---|---|
| Mitchell Sullivan, MD Po Box 83, Lyndonville, VT 05851-0083 Ph: (802) 748-9501 | Mitchell Sullivan, MD 195 Industrial Pkwy, Lyndonville, VT 05851-4511 Ph: (802) 748-9501 |