Provider Demographics
NPI:1285696864
Name:FITZGERALD, VERA ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:VERA
Middle Name:ELLEN
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0249
Mailing Address - Country:US
Mailing Address - Phone:336-679-4963
Mailing Address - Fax:336-679-2549
Practice Address - Street 1:108 S STATE ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8249
Practice Address - Country:US
Practice Address - Phone:336-679-2733
Practice Address - Fax:336-679-6263
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC33822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC195349OtherMEDCOST
NC8932271Medicaid
NC144KPOtherBCBS OF NC
NC33822OtherLICENSE NUMBER
NC48802OtherPARTNERS/BLUE MEDICARE
NC2061915Medicare PIN