Individual
MATTHEW FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3301 MERCY HEALTH BLVD, SUITE 525, CINCINNATI, OH 45211-1118
(513) 841-7700
(513) 841-7701
Mailing address
2000 JOSEPH E SANKER BLVD, CINCINNATI, OH 45212-1979
(513) 841-7400
(513) 841-7402
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301094972
MI
208800000X
Urology Physician
35125792
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC2433
MEDICARE RR
OH
Enumeration date
07/17/2009
Last updated
06/19/2015
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