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NPI Code Detail

MEDICARE: MITCHELL FULLER MD

MEDICARE: MITCHELL FULLER 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
1390200000XStudent in an Organized Health Care Education/Training Program
2207L00000XAnesthesiology Physician35240NH

General Provider Information

NPI Number : 1851978837
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITCHELL FULLER MD
Provider Business Mailing Address
First Line : 1 MEDICAL CENTER DR
Second Line :
City : LEBANON
State : NH
Zip : 03756-1000
Country : US
Telephone Number : 603-650-5000
Fax Number :
Provider Business Practice Location Address
First Line : 1 MEDICAL CENTER DR
Second Line :
City : LEBANON
State : NH
Zip : 03756-0001
Country : US
Telephone Number : 603-650-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2021
Last Update Date : 07/29/2025

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