Provider Demographics
NPI:1215999321
Name:FITZGERALD, KATHLEEN M (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SOUTH GARDEN WAY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-228-3400
Mailing Address - Fax:541-284-2937
Practice Address - Street 1:330 S GARDEN WAY
Practice Address - Street 2:SUITE 270
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8176
Practice Address - Country:US
Practice Address - Phone:541-228-3400
Practice Address - Fax:541-284-2937
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17475174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00429041OtherRAILROAD MEDICARE
OR2329OtherLIPA
OR033345Medicaid
OR085564000OtherBLUE CROSS
ORP00429041OtherRAILROAD MEDICARE
ORR138110Medicare PIN