Provider Demographics
NPI:1104315290
Name:FITZGERALD, THOMAS PATRICK (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 MICHIGAN AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2916
Mailing Address - Country:US
Mailing Address - Phone:202-476-5000
Mailing Address - Fax:732-776-4798
Practice Address - Street 1:1945 STATE ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07754
Practice Address - Country:US
Practice Address - Phone:732-776-4483
Practice Address - Fax:732-776-4798
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO2100012962080P0214X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology