Individual
DR. LONNIE EDWARD FULLER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3700 FLEET ST., SUITE 200, BALTIMORE, MD 21224
(410) 558-4900
(410) 522-1475
Mailing address
3501 SINCLAIR LN, BALTIMORE, MD 21213-2029
(410) 732-8800
(410) 534-2392
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D73006
MD
207R00000X
Internal Medicine Physician
MD041830L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001241798
—
PA
Enumeration date
09/20/2006
Last updated
11/05/2015
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