Healthcare Provider Details

I. General information

NPI: 1093505851
Provider Name (Legal Business Name): MARSHALL HAVEN FULTON II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GEORGE ST
YORK PA
17403-3676
US

IV. Provider business mailing address

1010 SKYVIEW DR
YORK PA
17406-3275
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-2345
  • Fax:
Mailing address:
  • Phone: 443-710-1235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR231225
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR231225
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: