MEDICARE: DR. BRIAN LAURENCE FULTON 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	207RI0011X	Interventional Cardiology Physician	MD466944	PA
2	207R00000X	Internal Medicine Physician	MD466944	PA

General Provider Information

NPI Number	:	1780039248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN LAURENCE FULTON MD

Provider Business Mailing Address
First Line	:	3400 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5127
Country	:	US
Telephone Number	:	215-662-7355
Fax Number	:	215-349-8444

Provider Business Practice Location Address
First Line	:	3400 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4206
Country	:	US
Telephone Number	:	215-662-7355
Fax Number	:	215-349-8444

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

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	02/02/2026

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