Healthcare Provider Details

I. General information

NPI: 1033110085
Provider Name (Legal Business Name): BRIAN SCOTT FULTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 WASHINGTON PIKE STE 45A
BRIDGEVILLE PA
15017-2827
US

IV. Provider business mailing address

100 TRICH DR STE 2
WASHINGTON PA
15301-5990
US

V. Phone/Fax

Practice location:
  • Phone: 412-302-5299
  • Fax:
Mailing address:
  • Phone: 724-225-8657
  • Fax: 724-884-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA051934
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: