Healthcare Provider Details

I. General information

NPI: 1063589109
Provider Name (Legal Business Name): KATHERINE FULLERTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BELLEVUE HOSPITAL CENTER FIRST AVENUE AND 27TH STREET
NEW YORK NY
10016
US

IV. Provider business mailing address

301 E 17TH ST RM 204, PEDIATRICS
NEW YORK NY
10003-3804
US

V. Phone/Fax

Practice location:
  • Phone: 202-302-4985
  • Fax:
Mailing address:
  • Phone: 202-302-4985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number236109
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: