Healthcare Provider Details

I. General information

NPI: 1487634333
Provider Name (Legal Business Name): DWIGHT CATOR FULTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 CHARLES MORRIS COURT SE MILITARY SEALIFT COMMAND, WASHINGTON NAVY YARD
WASHINGTON DC
20398-5540
US

IV. Provider business mailing address

635 FIRST ST APT 203
ALEXANDRIA VA
22314-1571
US

V. Phone/Fax

Practice location:
  • Phone: 202-685-0726
  • Fax:
Mailing address:
  • Phone: 703-299-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101055109
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: