Provider Demographics
NPI:1588702187
Name:FITZGERALD, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:792 COLLEGE PKWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3052
Mailing Address - Country:US
Mailing Address - Phone:802-655-4911
Mailing Address - Fax:802-655-8692
Practice Address - Street 1:792 COLLEGE PKWY
Practice Address - Street 2:SUITE 303
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3052
Practice Address - Country:US
Practice Address - Phone:802-655-4911
Practice Address - Fax:802-655-8692
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0007069207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006012Medicaid
VT0006012Medicaid
VTD03331Medicare UPIN