Provider Demographics
NPI:1346099587
Name:FITCH, DOUGLAS LEE
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:LEE
Last Name:FITCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HOBART DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2978
Mailing Address - Country:US
Mailing Address - Phone:937-545-9497
Mailing Address - Fax:
Practice Address - Street 1:2125 S COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-4257
Practice Address - Country:US
Practice Address - Phone:937-405-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide