Provider Demographics
NPI:1215045091
Name:FITZ, DAVID G (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:FITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2496
Mailing Address - Country:US
Mailing Address - Phone:207-775-3446
Mailing Address - Fax:207-879-1646
Practice Address - Street 1:244 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2496
Practice Address - Country:US
Practice Address - Phone:207-775-3446
Practice Address - Fax:207-879-1646
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011899208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Not Answered2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
D03592Medicare UPIN
MEFIMM0773Medicare ID - Type Unspecified