Provider Demographics
NPI:1992790927
Name:FITZSIMMONS, AMY (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SECOND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3830
Mailing Address - Country:US
Mailing Address - Phone:215-322-7550
Mailing Address - Fax:215-322-7117
Practice Address - Street 1:44 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3830
Practice Address - Country:US
Practice Address - Phone:215-322-7550
Practice Address - Fax:215-322-7117
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045677L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADF3318OtherTRAVELERS MEDICARE
PA0014219740006Medicaid
PADF3318OtherTRAVELERS MEDICARE
F58575Medicare UPIN