Provider Demographics
NPI:1174359848
Name:FULLER, EMMA F (PA-C)
Entity type:Individual
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First Name:EMMA
Middle Name:F
Last Name:FULLER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CENTER PLACE
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-6610
Practice Address - Fax:617-638-6616
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2025-01-07
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant