Provider Demographics
NPI:1124857784
Name:FULFORD, NATHANIEL SCOTT
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:SCOTT
Last Name:FULFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 HALE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2098
Mailing Address - Country:US
Mailing Address - Phone:978-927-0585
Mailing Address - Fax:
Practice Address - Street 1:376 HALE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2098
Practice Address - Country:US
Practice Address - Phone:978-927-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer