Provider Demographics
NPI:1063496149
Name:FULORIA, MAMTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAMTA
Middle Name:
Last Name:FULORIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HICKORY PL
Mailing Address - Street 2:APT. L3
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1448
Mailing Address - Country:US
Mailing Address - Phone:732-318-8753
Mailing Address - Fax:
Practice Address - Street 1:25 HICKORY PLACE
Practice Address - Street 2:APT. L3
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-3005
Practice Address - Country:US
Practice Address - Phone:732-318-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98016472080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12940Medicare UPIN