Provider Demographics
NPI:1376559351
Name:FULLER, JOSEPH EDWARD JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:FULLER
Suffix:JR
Gender:M
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:ROCHESTER HILL FAMILY PRACTICE
Mailing Address - Street 2:FRISBIE MEMORIAL HOSPITAL
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867
Mailing Address - Country:US
Mailing Address - Phone:603-335-2401
Mailing Address - Fax:
Practice Address - Street 1:245 ROCHESTER HILL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1775
Practice Address - Country:US
Practice Address - Phone:603-335-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2143993OtherCONNECTICARE
CTP2877320OtherOXFORD HEALTH PLANS
CT0R0176OtherHEALTHNET
CT010023719CT01OtherANTHEM BLUE SHIELD
CT050298OtherCONNECTICARE
CT001237197Medicaid
CT080121275OtherRAILROAD MEDICARE
CT010023719CT01OtherANTHEM BLUE SHIELD
CT080000136Medicare ID - Type Unspecified