Individual
DR. ITHIEL LOKEN AMES FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17 BELMONT AVE, ANESTHESIOLOGY DEPT, BRATTLEBORO, VT 05301-7601
(802) 257-8220
Mailing address
320 POMFRET ST, PUTNAM, CT 06260-1836
(802) 760-8259
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0420011774
VT
207L00000X
Anesthesiology Physician
Primary
67242
CT
207L00000X
Anesthesiology Physician
84251
WI
Other
Enumeration date
04/25/2007
Last updated
01/06/2026
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