Provider Demographics
NPI:1427039601
Name:FULLERTON, CATHERINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:A
Last Name:FULLERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 LONGWOOD AVE
Mailing Address - Street 2:DEPARTMENT OF HEALTH CARE POLICY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5821
Mailing Address - Country:US
Mailing Address - Phone:617-432-4356
Mailing Address - Fax:866-444-7815
Practice Address - Street 1:1130 MASSACHUSETTS AVE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5204
Practice Address - Country:US
Practice Address - Phone:617-395-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2217182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry