MEDICARE: SHANNON DEE FULLERTON 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	207V00000X	Obstetrics & Gynecology Physician	205500	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	042297845	OTHER	UNITED HEALTH CARE
2	042297845	OTHER	MULTI-PLAN/PHCS
3	1821099110	OTHER	NEIGHBORHOOD HEALTH PLAN
4	205500	OTHER	TUFTS/TMP
5	AA279482	OTHER	HARVARD PILGRIM
6	042297845	OTHER	GIC/UNICARE
7	042297845	OTHER	TRICARE
8	042297845	OTHER	HCVM/FIRST HEALTH/COVENTRY
9	9034507	OTHER	CIGNA
10	976196 08	OTHER	NETWORK HEALTH
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	1821099110	OTHER	FALLON
13	7151128	OTHER	AETNA
14	SS0128	OTHER	BCBSMA

General Provider Information

NPI Number	:	1821099110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON DEE FULLERTON MD

Provider Business Mailing Address
First Line	:	141 LONGWATER DR
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1632
Country	:	US
Telephone Number	:	781-878-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 PERFORMANCE DR
Second Line	:	ENTRY 2
City	:	WEYMOUTH
State	:	MA
Zip	:	02189-3141
Country	:	US
Telephone Number	:	781-682-8000
Fax Number	:	781-335-1412

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	01/08/2014

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