MEDICARE: TIMOTHY FULLERTON

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	207Q00000X	Family Medicine Physician	OS016025	PA

General Provider Information

NPI Number	:	1295964195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY FULLERTON

Provider Business Mailing Address
First Line	:	100 SHENANGO AVE
Second Line	:	P.O. BOX 716
City	:	SHARON
State	:	PA
Zip	:	16146-1503
Country	:	US
Telephone Number	:	724-662-2650
Fax Number	:	724-662-1338

Provider Business Practice Location Address
First Line	:	737 GREENVILLE RD
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-5070
Country	:	US
Telephone Number	:	724-662-2650
Fax Number	:	724-662-1338

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

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	05/14/2025

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