MEDICARE: TED FAULL 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	207Q00000X	Family Medicine Physician	36082109	IL
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	35.091967	OH

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	:	1770560724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TED FAULL MD

Provider Business Mailing Address
First Line	:	7341 EISENHOWER DR
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-5900
Country	:	US
Telephone Number	:	330-729-8977
Fax Number	:	330-729-8959

Provider Business Practice Location Address
First Line	:	900 TRAILWOOD DR
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-5007
Country	:	US
Telephone Number	:	330-726-2575
Fax Number	:	330-921-9319

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	04/09/2024

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Directions to “ TED FAULL MD” Practice Location

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