Provider Demographics
NPI:1942414115
Name:FULCHIERO, GREGORY JOHN JR (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:FULCHIERO
Suffix:JR
Gender:M
Credentials:MD, MS
Other - Prefix:
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Mailing Address - Street 1:2525 9TH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2014
Mailing Address - Country:US
Mailing Address - Phone:814-943-7546
Mailing Address - Fax:814-943-7543
Practice Address - Street 1:2525 9TH AVE STE 2A
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2014
Practice Address - Country:US
Practice Address - Phone:814-943-7546
Practice Address - Fax:814-943-7543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432947207ND0101X, 207NS0135X, 207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology