Doctor Name: | DR. TIMOTHY FULLERTON |
NPI Number: | 1295964195 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | OT013079 |
Business Practice Address: | 737 Greenville Rd Mercer, PA - 161375023 |
Business Phone Number: | 7246622650 |
Business Fax Number: | 7246621338 |
Mailing Address: | 100 Shenango Ave, P.o. Box 716 SHARON |
State: | PA |
Postal Code: | 161461503 |
Phone Number: | 7246622650 |
Fax Number: | 7246621338 |
NPI Enumeration Date: | 07/13/2009 |
NPI Last Update Date: | 12/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | OT013079 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |