Provider Demographics
NPI:1639128739
Name:FULTON, VIRGINIA JEAN (NP)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:JEAN
Last Name:FULTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:JEAN
Other - Last Name:ANGERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:12254 ROCKVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-230-2767
Mailing Address - Fax:
Practice Address - Street 1:12254 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-230-2767
Practice Address - Fax:301-230-2780
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003108A363LP0200X
NY381890363LP0200X
IN71003108B363LP0200X
MDR122264363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699367200Medicaid
MD699367200Medicaid
MDP49844Medicare UPIN