MEDICARE: DR. ERIC DAVID FULCHER 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
1	207P00000X	Emergency Medicine Physician	41464	KY
2	207P00000X	Emergency Medicine Physician	35.089940	OH

General Provider Information

NPI Number	:	1306030499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC DAVID FULCHER M.D.

Provider Business Mailing Address
First Line	:	3835 INDIAN RD
Second Line	:
City	:	OTTAWA HILLS
State	:	OH
Zip	:	43606-2339
Country	:	US
Telephone Number	:	419-754-3669
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 INDIAN RD
Second Line	:
City	:	OTTAWA HILLS
State	:	OH
Zip	:	43606-2339
Country	:	US
Telephone Number	:	419-754-3669
Fax Number	:

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	06/07/2023

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