Provider Demographics
NPI:1730478728
Name:FULLER, ANDREW P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:FULLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:25 CARLETON ST
Mailing Address - Street 2:E23-3 SOUTH
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1323
Mailing Address - Country:US
Mailing Address - Phone:617-253-2916
Mailing Address - Fax:617-253-0162
Practice Address - Street 1:25 CARLETON ST
Practice Address - Street 2:E23-3 SOUTH
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1323
Practice Address - Country:US
Practice Address - Phone:617-253-2916
Practice Address - Fax:617-253-0162
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2017-04-12
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Provider Licenses
StateLicense IDTaxonomies
MA2620152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry