Provider Demographics
NPI:1992796957
Name:FITZGERALD, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CYPRESS ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3600
Mailing Address - Country:US
Mailing Address - Phone:603-668-8042
Mailing Address - Fax:603-641-0858
Practice Address - Street 1:445 CYPRESS ST
Practice Address - Street 2:SUITE 9
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3600
Practice Address - Country:US
Practice Address - Phone:603-668-8042
Practice Address - Fax:603-641-0858
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2140OtherCIGNA PIN
NHP502092OtherOXFORD PIN
NH80004208Medicaid
NHNH1280OtherHPHC PIN
NHD03476OtherANTHEM REFERRING UPIN
NH0441899OtherUHC PIN
NH406438OtherTUFTS PIN
NH2192430OtherAETNA PIN
NHD03476OtherANTHEM REFERRING UPIN
NH406438OtherTUFTS PIN