Basic Information
| Provider Information | |||||||||
| NPI: | 1710978671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FULTON | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9135 | ||||||||
| Address2: | ATT: SHARON SILVA | ||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024469135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038904404 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 LONGWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021155724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173552793 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 01/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 58948 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 0111457 | 05 | MA | MEDICAID | 7500359 | 01 | MA | UNITED HEALTHCARE MA | OTHER | 99134101 | 01 | MA | NETWORK HEALTH | OTHER | AA9214 | 01 | MA | HARVARD PILGRIM | OTHER | E05248 | 01 | MA | BCBS MA | OTHER | 6162 | 01 | MA | HEALTH NET | OTHER | DF11109 | 05 | RI | MEDICAID | 11530 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | B20017601 | 01 | MA | CIGNA MA | OTHER |