Provider Demographics
NPI:1356315964
Name:FULLER, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:FULLER
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:2 1/2 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4447
Mailing Address - Country:US
Mailing Address - Phone:603-228-1521
Mailing Address - Fax:603-225-2510
Practice Address - Street 1:2 1/2 BEACON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4447
Practice Address - Country:US
Practice Address - Phone:603-228-1521
Practice Address - Fax:603-225-2510
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH99462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80004380Medicaid
NHG43779Medicare UPIN
NHRE438001Medicare PIN