Individual
DR. FULTON CHRISTOPHER KORNACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1153 CENTRE ST, SUITE 54, JAMAICA PLAIN, MA 02130-3446
(617) 522-1734
(617) 522-8325
Mailing address
1153 CENTRE ST, SUITE 54, JAMAICA PLAIN, MA 02130-3446
(617) 522-1734
(617) 522-8325
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
49472
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3002918
—
MA
01
—
705751
TUFTS
MA
01
—
E45018
BCBS
MA
Enumeration date
11/07/2005
Last updated
06/27/2011
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