Provider Demographics
NPI:1154670271
Name:FULGINITI, LAUREN (PA)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:FULGINITI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 18TH ST NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5217
Mailing Address - Country:US
Mailing Address - Phone:202-835-2222
Mailing Address - Fax:202-969-1798
Practice Address - Street 1:1015 18TH ST NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5217
Practice Address - Country:US
Practice Address - Phone:202-835-2222
Practice Address - Fax:202-969-1798
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC08735363A00000X
363AS0400X
DCPA030868363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical