Individual
DEBRA FULLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4905 W TILGHMAN ST, SUITE 250, ALLENTOWN, PA 18104-9130
(484) 866-9583
(610) 366-1147
Mailing address
4905 W TILGHMAN ST, SUITE 250, ALLENTOWN, PA 18104-9130
(484) 866-9583
(610) 366-1147
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
OS007883L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097909
THREE RIVERS
PA
05
—
0017498640
—
PA
01
—
0163943
KHP CENTRAL
PA
01
—
01749864
GATEWAY
PA
01
—
0671239000
INDEP. BLUE CROSS
PA
01
—
1105125
KEYSTONE MERCY
PA
01
—
163943
HIGHMARK
PA
Enumeration date
10/07/2005
Last updated
02/27/2014
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