Individual
DONNA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
11722 REISTERSTOWN ROAD, REISTERSTOWN, MD 21136
(410) 833-5000
(410) 833-1433
Mailing address
415 SAMANTHA CT, GLYNDON, MD 21071
(410) 833-3626
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0001453
MD
Other
Enumeration date
11/04/2005
Last updated
02/23/2010
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