Provider Demographics
NPI:1275519357
Name:FULBRIGHT, DEBORAH KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:KAY
Last Name:FULBRIGHT
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:PO BOX 5468
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-5468
Mailing Address - Country:US
Mailing Address - Phone:276-670-2400
Mailing Address - Fax:276-670-2406
Practice Address - Street 1:2700 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9494
Practice Address - Country:US
Practice Address - Phone:919-731-6012
Practice Address - Fax:919-731-6616
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27184207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8934089Medicaid
NC34089OtherBCBS
72872OtherMEDCOST
NC2155038Medicare ID - Type Unspecified
C83923Medicare UPIN