Provider Demographics
NPI:1205171311
Name:FULLERTON, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:FULLERTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 GAR HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-4224
Mailing Address - Country:US
Mailing Address - Phone:508-262-0588
Mailing Address - Fax:508-947-8640
Practice Address - Street 1:1162 GAR HWY STE 7
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4224
Practice Address - Country:US
Practice Address - Phone:508-262-0588
Practice Address - Fax:508-947-8640
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist