=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174721823
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN CHARLES FULOP M.D., M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2007
-----------------------------------------------------
Last Update Date | 07/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 SPRUCE ST 3 SILVERSTEIN
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19104-4238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-662-3487
-----------------------------------------------------
Fax | 215-349-5534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 SPRUCE ST 3 SILVERSTEIN
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19104-4238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-662-3487
-----------------------------------------------------
Fax | 215-349-5534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 57.006078
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 35-090780
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | MD461368
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------