Provider Demographics
NPI:1285608554
Name:FULWILER, CARL E (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:E
Last Name:FULWILER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:TURNPIKE STATION
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-0062
Mailing Address - Country:US
Mailing Address - Phone:508-334-8815
Mailing Address - Fax:508-334-5374
Practice Address - Street 1:96 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-3810
Practice Address - Country:US
Practice Address - Phone:774-329-9228
Practice Address - Fax:508-856-8700
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2015-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA802082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3150445Medicaid
MAG24550Medicare UPIN
MA3150445Medicaid