Provider Demographics
NPI:1215929377
Name:FITZ, GRAHAME W (MD)
Entity type:Individual
Prefix:DR
First Name:GRAHAME
Middle Name:W
Last Name:FITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:6 WELLNESS WAY STE 109
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2142
Practice Address - Country:US
Practice Address - Phone:518-785-5882
Practice Address - Fax:518-783-8510
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2024-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY147616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01160278Medicaid
NY01160278Medicaid
NYRA2939Medicare PIN