Individual
MATTHEW J FASULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
169 WADSWORTH DR, NORTH CHESTERFIELD, VA 23236-4500
(804) 330-4901
Mailing address
165 WADSWORTH DR, NORTH CHESTERFIELD, VA 23236-4500
(804) 330-4901
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
0102207822
VA
Other
Enumeration date
03/28/2016
Last updated
04/12/2024
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