Provider Demographics
NPI:1447408182
Name:FULTON, CLIFFORD WARREN I (LMT)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:WARREN
Last Name:FULTON
Suffix:I
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 546
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-8910
Mailing Address - Country:US
Mailing Address - Phone:304-844-6063
Mailing Address - Fax:
Practice Address - Street 1:1200 WEST VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-1953
Practice Address - Country:US
Practice Address - Phone:304-326-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist