Individual
ELIZABETH A FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
407 MAIN ST, SPENCER, MA 01562-1909
(508) 885-9737
(508) 885-6139
Mailing address
630 PLANTATION ST, WORCESTER, MA 01605-2038
(508) 885-9737
(508) 885-6139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
75454
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042472266
PRIVATE HEALTHCARE SYSTEM
—
01
—
1150053
FIRST HEALTH
—
01
—
1669433645
BLUE CROSS BLUE SHIELD OF MA
MA
05
—
3104796
—
MA
01
—
4545003
AETNA US HEALTHCARE
—
01
—
9143201
CIGNA HEALTH PLAN
—
01
—
9900893
FALLON COMMUNITY HEALTH P
—
01
—
AA1214
HARVARD PILGRIM HEALTHCAR
—
01
—
J12908
BLUE SHIELD INDEMNITY
—
Enumeration date
03/30/2006
Last updated
08/17/2017
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