Healthcare Provider Details

I. General information

NPI: 1679589840
Provider Name (Legal Business Name): MICHAEL ALAIN FULOP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 S NORTH POINT RD KEYPOINT HEALTH SERVICES
BALTIMORE MD
21224-3338
US

IV. Provider business mailing address

11516 HUNTERS RUN DR
COCKEYSVILLE MD
21030-1941
US

V. Phone/Fax

Practice location:
  • Phone: 443-216-4800
  • Fax:
Mailing address:
  • Phone: 410-683-8304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD37789
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: