MEDICARE: LISA FITZPATRICK MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	048147	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588664056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA FITZPATRICK MD, MPH

Provider Business Mailing Address
First Line	:	10211 KINDLY CT
Second Line	:
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-3946
Country	:	US
Telephone Number	:
Fax Number	:	404-756-1402

Provider Business Practice Location Address
First Line	:	2041 GEORGIA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20060-0001
Country	:	US
Telephone Number	:	404-964-5425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	05/08/2008

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