Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | C10002580 | DE |
NPI | 1346225075 |
---|---|
Provider Name | Gerard Fulda |
First Address | Wilmington, DE 19805-7170 |
Second Address | Newark, DE 19713-2072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 23/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E54654 | (02) | DE |