Provider Demographics
NPI:1396909008
Name:FULLER, AARON E (DO)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:E
Last Name:FULLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1889
Mailing Address - Country:US
Mailing Address - Phone:315-261-5550
Mailing Address - Fax:315-261-5599
Practice Address - Street 1:49 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1889
Practice Address - Country:US
Practice Address - Phone:315-261-5550
Practice Address - Fax:315-261-5599
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine