MR. JEREMY ISAIAH SULLIVAN MD NPI 1184151730

NPI Information

NPI: 1184151730
Provider Name: MR. JEREMY ISAIAH SULLIVAN, MD
Classification: Internal Medicine - 207RR0500X
Entity Type: Individual

Specialization: Rheumatology

PECOS Registration: Yes

Address:
1918 RANDOLPH RD STE 600
CHARLOTTE, NC
ZIP 28207
Phone: (704) 342-0252
Get Directions

MR. Jeremy Isaiah Sullivan, MD is a rheumatology internal medicine in Charlotte, NC with 7 years of experience. The provider is an internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases. MR. Jeremy Isaiah Sullivan, MD NPI is 1184151730. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
Graduation Year:2017

The provider's business location address is:

1918 RANDOLPH RD STE 600
CHARLOTTE, NC
ZIP 28207-198
Phone: (704) 342-0252
Fax: (980) 533-7801

The NPI 1184151730 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/15/2017 and was last updated on 10/10/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207R00000X	Internal Medicine		2023-01715	NORTH CAROLINA	No
2	207RR0500X	Internal Medicine	Rheumatology	2023-01715	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7483509	OTHER		UHC
2	20ZYO	OTHER	NORTH CAROLINA	BCBS
3	1184151730	MEDICAID	NORTH CAROLINA
4	7960220	OTHER	NORTH CAROLINA	CIGNA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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