MEDICARE: DR. MARK A FULTON M.D.

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	207T00000X	Neurological Surgery Physician	ME105861	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CS864X	OTHER	FL	MEDICARE
3	CS864Y	OTHER	FL	MEDICARE

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
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962409169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A FULTON M.D.

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-434-1981
Fax Number	:	321-951-7408

Provider Business Practice Location Address
First Line	:	1251 S HICKORY ST
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3221
Country	:	US
Telephone Number	:	321-434-3420
Fax Number	:	321-434-3423

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	08/31/2017

Similar Medicare Providers

1447246509 — DR. NANA S AMIRIDZE MD, PHD
Practice Location Address:

1251 S HICKORY ST
MELBOURNE, FL
32901-3221

Practice Phone: 321-434-3420
Practice Fax: 321-434-3423

1851347678 — DR. RAFAEL ALLENDE M.D.
Practice Location Address:

1251 HICKORY ST
MELBOURNE, FL
32901-3221

Practice Phone: 321-434-3420
Practice Fax: 321-434-3423

1316961915 — ACTIVE CHIROPRACTIC, LLC
Practice Location Address:

1251 HICKORY ST
MELBOURNE, FL
32901-3221

Practice Phone: 321-255-3003
Practice Fax: 321-255-3005

1821002684 — WESLEY E GRIFFITT MD
Practice Location Address:

1251 HICKORY ST
MELBOURNE, FL
32901-3221

Practice Phone: 321-434-3420
Practice Fax: 321-434-3423

1396889150 — MELBOURNE MEDICINE & SURGERY ASSOC
Practice Location Address:

1251 HICKORY ST STE A
MELBOURNE, FL
32901-3221

Practice Phone: 321-723-3113
Practice Fax: 321-768-0491

1396917522 — KIMBERLY ANN VONDERLIETH PA
Practice Location Address:

1251 HICKORY ST
MELBOURNE, FL
32901-3221

Practice Phone: 321-434-3420
Practice Fax: 321-434-3423

Directions to “ DR. MARK A FULTON M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.