Provider Information for 1467450395
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
ROBERT FULLER MD
Sex: Male
NPI: 1467450395
Last Updated: 2023-01-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1467450395 | ||||||||||||||
| Enumeration Date | 2005-07-13 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 65 KANE ST WEST HARTFORD, CT 06119-2110 United States Phone: | Fax: | ||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-0001 United States Phone: 860-679-3486 | Fax:860-679-3489 | ||||||||||||||
| Secondary Practice Address(es) | |||||||||||||||
| Health Information Exchange |
| ||||||||||||||
| Other Identifiers |
| ||||||||||||||
| Taxonomy |
|