Healthcare Provider Details

I. General information

NPI: 1801808209
Provider Name (Legal Business Name): DREW C FULLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOSPITAL DR STE 223
GLEN BURNIE MD
21061-5707
US

IV. Provider business mailing address

7310 RITCHIE HWY STE 516
GLEN BURNIE MD
21061-3099
US

V. Phone/Fax

Practice location:
  • Phone: 443-221-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberD0053298
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0053298
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberD0053298
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: