Healthcare Provider Details

I. General information

NPI: 1679405666
Provider Name (Legal Business Name): PHILLIP FULCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GLOBAL WAY STE 103
LINTHICUM HEIGHTS MD
21090-2265
US

IV. Provider business mailing address

2405 PALMER CIR STE 100
NORMAN OK
73069-6351
US

V. Phone/Fax

Practice location:
  • Phone: 443-457-3972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: