Provider Demographics
NPI:1366543597
Name:FITZGERALD, JUDITH (DO)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ULUNIU ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2519
Mailing Address - Country:US
Mailing Address - Phone:808-261-3326
Mailing Address - Fax:808-263-4604
Practice Address - Street 1:407 ULUNIU ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2519
Practice Address - Country:US
Practice Address - Phone:808-261-3326
Practice Address - Fax:808-263-4604
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-755207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000201558OtherHMSA
HI074403Medicaid
HI074403Medicaid
F48079Medicare UPIN