MEDICARE: DR. VIRGINIA S FULLER MD

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
1	207L00000X	Anesthesiology Physician	200101045	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295714491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA S FULLER MD

Provider Business Mailing Address
First Line	:	PO BOX 65457
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28265-0457
Country	:	US
Telephone Number	:	706-860-2701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 COLLEGE ST
Second Line	:	ANESTHESIA DEPT
City	:	OXFORD
State	:	NC
Zip	:	27565-2507
Country	:	US
Telephone Number	:	919-690-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	10/05/2007

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