1144222415 NPI number — DR. EDWARD P FITZPATRICK M.D.

Table of content: DR. EDWARD P FITZPATRICK M.D. (NPI 1144222415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144222415 NPI number — DR. EDWARD P FITZPATRICK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZPATRICK
Provider First Name:
EDWARD
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144222415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 KENSINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06051-3916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-826-4460
Provider Business Mailing Address Fax Number:
860-224-6260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 LAKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRITAIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06052-1396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-826-4460
Provider Business Practice Location Address Fax Number:
860-826-4436
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  035599 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 035599-1831 . This is a "CONNECTICARE MERIDEN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1255448155 . This is a "GHMC GRP NPI ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004214433 . This is a "GHMC GRP CAID ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060173 . This is a "HEALTH NET PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CT5599 . This is a "EYE MED VISION CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 035599-3714 . This is a "CONNECTICARE NB LOCATION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 136392 . This is a "WELLCARE MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010035599CT01 . This is a "BCBS NB LOCATION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010035599CT03 . This is a "BCBS MERIDEN LOCATION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 914443 . This is a "BLOCK VISION ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C01373 . This is a "GHMC GRP MEDICARE ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P422705 . This is a "OXFORD ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 932774 . This is a "HEALTH NET REF ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 01035599 . This is a "CIGNA PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5907379 . This is a "AETNA REF ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001355991 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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