1033406319 NPI number — DR. STEPHANIE LENAY FITZPATRICK PH.D.

Table of content: MRS. LACEDA HOLIFIELD (NPI 1497486088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033406319 NPI number — DR. STEPHANIE LENAY FITZPATRICK PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZPATRICK
Provider First Name:
STEPHANIE
Provider Middle Name:
LENAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1033406319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 FLANDERS CT
Provider Second Line Business Mailing Address:
APT. F
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21236-5149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-345-1476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2024 E. MONUMENT ST.
Provider Second Line Business Practice Location Address:
SUITE 2-624
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-502-2794
Provider Business Practice Location Address Fax Number:
410-955-0476
Provider Enumeration Date:
07/07/2011

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: 103TC0700X , with the licence number:  99999999999999999999 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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