| Ryan P Fulton, | |
|
60 Market Center Way, Daleville, VA 24083-3261 | |
| (540) 992-1251 | |
| Not Available |
| Full Name | Ryan P Fulton |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Ryan P Fulton, 213 S Jefferson St Ste 1006, Roanoke, VA 24011-1713 Ph: () - | Ryan P 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 |