Provider Demographics
NPI:1548359979
Name:FULLER, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:FULLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 408
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7363
Mailing Address - Fax:856-968-8288
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 408
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-968-7363
Practice Address - Fax:856-968-8288
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-04-25
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Provider Licenses
StateLicense IDTaxonomies
NJMA67224207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1165178OtherHEALTHNET
NJ3K5443OtherHEALTHNET
PA01707828Medicaid
NJ2884943OtherAETNA
NJ01000344701OtherAMERICHOICES
NJ7700202Medicaid
NJP2697348OtherOXFORD
DE1000025140Medicaid
NJ36089OtherUNIVERSITY HEALTH PLAN
NJ1318485OtherPA BS HIGHMARK
NJ2011301000OtherAMERIHEALTH/KEYSTONE/IBC/PA BS
NJ1114872002OtherCIGNA
NJ2260119OtherUNITED HEALTHCARE
NJ60007696OtherHORIZON NJ HEALTH
NJ3K5443OtherHEALTHNET
NJ36089OtherUNIVERSITY HEALTH PLAN
NJ050755DSTMedicare PIN