Provider Demographics
NPI:1487634333
Name:FULTON, DWIGHT CATOR (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:CATOR
Last Name:FULTON
Suffix:
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 1:635 FIRST ST
Mailing Address - Street 2:APT 203
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1571
Mailing Address - Country:US
Mailing Address - Phone:703-299-2460
Mailing Address - Fax:
Practice Address - Street 1:914 CHARLES MORRIS COURT SE
Practice Address - Street 2:MILITARY SEALIFT COMMAND, WASHINGTON NAVY YARD
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20398-5540
Practice Address - Country:US
Practice Address - Phone:202-685-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010551092083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine