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NPI Code Detail

MEDICARE: DR. GEORGE F. FULLER M.D.

MEDICARE: DR. GEORGE F. FULLER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QG0300XGeriatric Medicine (Family Medicine) Physician027003CT
2207Q00000XFamily Medicine Physician027003CT

General Provider Information

NPI Number : 1154306462
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE F. FULLER M.D.
Provider Business Mailing Address
First Line : 14 S ORCHARD DR
Second Line :
City : AMHERST
State : MA
Zip : 01002-3039
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 421 N MAIN ST
Second Line :
City : LEEDS
State : MA
Zip : 01053-9764
Country : US
Telephone Number : 413-584-4040
Fax Number : 413-582-3121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2005
Last Update Date : 07/17/2007

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Directions to “ DR. GEORGE F. FULLER M.D.” Practice Location

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