Individual
ROBERT R FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1204 W MAIN ST, CHARLOTTESVILLE, VA 22908-1923
(434) 924-2500
(434) 244-9487
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
0101242146
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02532236
MY MEDICAID
NY
05
—
1010433
—
VT
01
—
C06778
GROU PTAN
VA
Enumeration date
08/01/2006
Last updated
08/09/2023
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