MEDICARE: GERARD FULDA 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	2086S0102X	Surgical Critical Care Physician	C10002580	DE

General Provider Information

NPI Number	:	1346225075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARD FULDA MD

Provider Business Mailing Address
First Line	:	PO BOX 30170
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19805-7170
Country	:	US
Telephone Number	:	302-623-7362
Fax Number	:	302-623-7374

Provider Business Practice Location Address
First Line	:	4735 OGLETOWN STANTON RD
Second Line	:	MEDICAL ARTS PAVILION 2, SUITE 3301
City	:	NEWARK
State	:	DE
Zip	:	19713-2072
Country	:	US
Telephone Number	:	302-623-4370
Fax Number	:	302-623-4375

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	06/23/2008

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