Provider Demographics
NPI:1659384352
Name:FULTON, JEFFREY A (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:FULTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-6656
Mailing Address - Fax:412-359-6653
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-6656
Practice Address - Fax:412-359-6653
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009093208G00000X
PAOS007677L208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
10927102OtherCAQH
PA001809908Medicaid
OH2754649Medicaid
PA001809908002Medicaid
OHH027670OtherMEDICARE PTAN