Provider Demographics
NPI:1912520479
Name:FOX-FULLER, JOSHUA THOMAS (MA)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:THOMAS
Last Name:FOX-FULLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:JOSHUA
Other - Middle Name:THOMAS
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 COMMONWEALTH AVE, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1200
Mailing Address - Country:US
Mailing Address - Phone:617-353-9610
Mailing Address - Fax:
Practice Address - Street 1:900 COMMONWEALTH AVE, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1200
Practice Address - Country:US
Practice Address - Phone:928-607-8536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program