Individual provider · NPI-1

Connor M Fultz, MD

Physical Medicine & Rehabilitation, Sports Medicine · Willow Grove, PA

NPI number1003435132
StatusActive
Last updated in NPPESSep 2, 2025

Details

NPI
1003435132
Entity type
Individual (NPI-1)
Name
Connor M Fultz
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Apr 9, 2020
Certification date
Sep 2, 2025
Last updated
Sep 2, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2081S0010X Physical Medicine & Rehabilitation, Sports MedicineMD486957PAYes

Practice location

2400 Maryland Rd Ste 20
Willow Grove, PA 19090-1732

Phone 800-321-9999 · Fax 267-479-1321

Mailing address

833 Chestnut St Ste 520
Philadelphia, PA 19107-4430

Phone 609-677-7003

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