Individual
MATTHEW PAUL FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2696
(617) 724-4100
(617) 726-7415
Mailing address
55 STATION LNDG APT 522W, MEDFORD, MA 02155-5055
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA100048
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/25/2022
Last updated
10/03/2023
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