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General NPI Number Information
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NPI Number | 1811038011
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Entity Type | Individual
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Provider Name | ROBIN H FULLER PA C
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 37 W GARDEN ST SUITE 105
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City | AUBURN
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State | NY
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Zip | 13021-2662
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Country | US
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Telephone | 315-252-0000
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Fax | 315-252-0070
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Provider Business Mailing Address
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Address Line | 17 LANSING ST AMMS, PC
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City | AUBURN
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State | NY
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Zip | 13021-1983
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Country | US
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Telephone | 315-252-0000
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Fax | 315-252-0070
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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 | 003118
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License Number State | NY
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