Donald Jenkins Fuller, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C0000378 Issued in MD

Practice address

401 N Broadway
RM 1360 Weinberg BLDG.
Baltimore, MD 21231-1146

Phone

(410) 955-8742

Fax

(410) 502-1746

NPI assigned

Mar 1, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295863587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216A BALDWIN MILL RD",
            "city": "JARRETTSVILLE",
            "state": "MD",
            "postal_code": "210841908",
            "telephone_number": "410-557-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N BROADWAY",
            "address_2": "RM 1360 WEINBERG BLDG.",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212311146",
            "telephone_number": "410-955-8742",
            "fax_number": "410-502-1746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "DONALD",
        "middle_name": "JENKINS",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0000378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Full Speed Physical Therapy
• Madison Fullard
• Shirely Cooper Fullard, MA, CCC-SLP
• Alice K Fuller, PA-C
• Benjamin Fuller
• Jacqueline L Fuller
• Lonnie Edward Fuller Jr., MD
• Robert Fuller, MD
• Katelin Fullerton, LCSW-C
• Joshua Fullwood

• Medical Physician Assistant in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.