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General NPI Number Information
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NPI Number | 1508811902
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Entity Type | Individual
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Provider Name | FULTON LUKBAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 100 HOSPITAL RD
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-4017
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Country | US
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Telephone | 301-855-1012
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 999
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City | HUNTINGTOWN
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State | MD
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Zip | 20639-0999
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Country | US
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Telephone | 410-535-3132
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Fax |
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | D0050963
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License Number State | MD
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