Ryan Fulton, | |
60 Market Center Way, Daleville, VA 24083-3261 | |
(540) 992-1251 | |
Not Available |
Full Name | Ryan Fulton |
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Gender | Male |
Speciality | Pediatrics |
Location | 60 Market Center Way, Daleville, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1346582228 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 0102204426 (Virginia) | Primary |
Entity Name | Carilion Healthcare Corporation |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1447206370 PECOS PAC ID: 5890607253 Enrollment ID: O20031106000273 |
Entity Name | Carilion Medical Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1730123472 PECOS PAC ID: 9830096585 Enrollment ID: O20040107000472 |
Mailing Address | Practice Location Address |
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Ryan Fulton, 60 Market Center Way, Daleville, VA 24083-3261 Ph: (540) 992-1251 | Ryan Fulton, 60 Market Center Way, Daleville, VA 24083-3261 Ph: (540) 992-1251 |
Amanda Mae Tiffany, Pediatrics Medicare: Medicare Enrolled Practice Location: 60 Market Center Way, Daleville, VA 24083 Phone: 540-992-1251 Fax: 540-992-5958 | |
Amy C Kryder, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 60 Market Center Way, Daleville, VA 24083 Phone: 540-992-1251 |