1801863691 NPI number — DR. PATRICIA G FITZPATRICK M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801863691 NPI number — DR. PATRICIA G FITZPATRICK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZPATRICK
Provider First Name:
PATRICIA
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1801863691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 HAGEN DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14625-2658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-338-2700
Provider Business Mailing Address Fax Number:
585-242-9663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 HAGEN DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14625-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-338-2700
Provider Business Practice Location Address Fax Number:
585-242-9663
Provider Enumeration Date:
03/01/2006

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: 207RC0000X , with the licence number:  143633 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X , with the licence number: 143633 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0001084044 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00833101 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6890 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: POO10143633 . This is a "EXCELLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 301133 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005251451 . This is a "HEALTH NOW (PARNALL)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4285979 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005251451 . This is a "COMM BLUE/BCBSWNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060047207 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2197784 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7701216 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: MDC187 . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PO10143633 . This is a "GRIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: RC60143633 . This is a "RCIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000525145003 . This is a "HEALTH NOW (LINDEN)" identifier . This identifiers is of the category "OTHER".




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