Individual
TERESA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10084 REISTERSTOWN RD STE 200B, OWINGS MILLS, MD 21117-4096
(410) 526-7993
(410) 526-5144
Mailing address
1 E UNIVERSITY PKWY UNIT 109, BALTIMORE, MD 21218-2432
(410) 235-1601
(410) 467-6881
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
D0058861
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400185100
—
MD
Enumeration date
03/14/2006
Last updated
12/21/2018
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