Provider Demographics
NPI:1427030683
Name:FITZPATRICK, JOHN T JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:FITZPATRICK
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:887 E BROADWAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-6235
Practice Address - Country:US
Practice Address - Phone:860-205-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4378452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD919374OtherCAREFIRST MD BCBS-WMG
MD035819300Medicaid
PA102368346Medicaid
PA1583870OtherGATEWAY-WMG
PA20091802OtherAMERIHEALTH MERCY-WMG
PA2116886OtherHIGHMARK BLUE SHIELD
PA281749OtherUNISON-WMG
PAP00752428Medicare PIN
PA1583870OtherGATEWAY-WMG