Provider Demographics
NPI:1215982673
Name:FITZSIMMONS, PATRICK J II (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:FITZSIMMONS
Suffix:II
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 1:802 NEW HOLLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2287
Mailing Address - Country:US
Mailing Address - Phone:717-291-0700
Mailing Address - Fax:717-291-9634
Practice Address - Street 1:802 NEW HOLLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2287
Practice Address - Country:US
Practice Address - Phone:717-291-0700
Practice Address - Fax:717-291-9634
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237511207RC0000X
PAMD455787207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA070193257Medicaid
VA070193257Medicaid
VA00X227C05Medicare PIN
VAH41612Medicare UPIN