Individual provider · Type 1 NPI

Carly Faith Fuller

Medical Physician Assistant · Woodbridge, VA

NPI number 1295293611 Active

Practice location

2300 Opitz Blvd
Woodbridge, VA 22191-3311

Call (703) 915-5550 Map

Mailing address

2151 Old Brick Rd
Glen Allen, VA 23060-5837

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000X0110007223 (VA)
Medical Physician Assistant Primary 363AM0700X0110007223 (VA)

Medical Physician Assistant: Definition to come...

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About NPI 1295293611

Carly Faith Fuller's National Provider Identifier is 1295293611, issued on Mar 5, 2019. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Woodbridge, VA. The record was last updated on Dec 29, 2022.