Provider Demographics
NPI:1215324017
Name:FITZGERALD, KATHRYN M (DO)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1240
Mailing Address - Country:US
Mailing Address - Phone:814-205-1900
Mailing Address - Fax:814-205-1902
Practice Address - Street 1:815 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1240
Practice Address - Country:US
Practice Address - Phone:814-205-1900
Practice Address - Fax:814-205-1902
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305671208600000X
PAOS023598208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty