Individual
RANDALL M FULCHIERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1520 S MAIN ST, # 2, DAYTON, OH 45409-2698
(937) 461-5815
(937) 461-2896
Mailing address
1520 S MAIN ST, # 2, DAYTON, OH 45409-2698
(937) 461-5815
(937) 461-2896
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
35068723
OH
207RP1001X
Pulmonary Disease Physician
Primary
35068723
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000012028
ANTHEM BCBS
OH
05
—
0168992
—
OH
01
—
4820105
UNITED HEALTHCARE
OH
Enumeration date
08/22/2005
Last updated
09/07/2007
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