MEDICARE: DR. DALIA FULOP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME94973	FL
2	2084D0003X	Diagnostic Neuroimaging (Psychiatry & Neurology) Physician	ME094973	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00291948	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40662	OTHER	FL	BLUE CROSS OF FLORIDA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578589198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALIA FULOP MD

Provider Business Mailing Address
First Line	:	8 MIRROR LAKE DR
Second Line	:	STE A
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-3101
Country	:	US
Telephone Number	:	386-673-2500
Fax Number	:	386-673-3204

Provider Business Practice Location Address
First Line	:	8 MIRROR LAKE DR
Second Line	:	STE A
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-3101
Country	:	US
Telephone Number	:	386-673-2500
Fax Number	:	386-673-3204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	09/27/2017

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Directions to “ DR. DALIA FULOP MD” Practice Location

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