Provider Demographics
NPI:1134126568
Name:FULLER, DANIEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:FULLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:26250 EUCLID AVE STE 611
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3693
Mailing Address - Country:US
Mailing Address - Phone:216-261-2606
Mailing Address - Fax:216-261-9814
Practice Address - Street 1:26250 EUCLID AVE
Practice Address - Street 2:SUITE 611
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3305
Practice Address - Country:US
Practice Address - Phone:216-261-2606
Practice Address - Fax:216-261-9814
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041455F208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH56958OtherUNITED HEALTHCARE
OHOC02324OtherNATIONWIDE HEALTH PLANS
OH000000127387OtherANTHEM
OH1764868001OtherCIGNA
OH0360247Medicaid
OH341106740031OtherCARESOURCE
OHR41455OtherSUMMA CARE
OH50453OtherQUAL CHOICE
OH4044677OtherAETNA