Provider Demographics
NPI:1225281546
Name:FULLER, LINDA JO (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:JO
Last Name:FULLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:751 TWINBROOK PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-1499
Mailing Address - Country:US
Mailing Address - Phone:240-777-1680
Mailing Address - Fax:240-777-3381
Practice Address - Street 1:751 TWINBROOK PKWY STE 2
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1499
Practice Address - Country:US
Practice Address - Phone:240-777-1680
Practice Address - Fax:240-777-3381
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00651642084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry