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General NPI Number Information
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NPI Number | 1033110085
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Entity Type | Individual
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Provider Name | BRIAN SCOTT FULTON PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1155 WASHINGTON PIKE STE 45A
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City | BRIDGEVILLE
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State | PA
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Zip | 15017-2827
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Country | US
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Telephone | 412-302-5299
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Fax |
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Provider Business Mailing Address
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Address Line | 100 TRICH DR STE 2
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City | WASHINGTON
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State | PA
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Zip | 15301-5990
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Country | US
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Telephone | 724-225-8657
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Fax | 724-884-0762
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA051934
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License Number State | PA
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