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NPI Code Detail

MEDICARE: DR. KYLE TYRONE FITZGERALD DO

MEDICARE: DR. KYLE TYRONE FITZGERALD DO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramPA

General Provider Information

NPI Number : 1861332108
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYLE TYRONE FITZGERALD DO
Provider Business Mailing Address
First Line : 10800 KNIGHTS RD
Second Line : ATTN: GRADUATE MEDICAL EDUCATION FAMILY MEDICINE
City : PHILADELPHIA
State : PA
Zip : 19114-4200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10800 KNIGHTS RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19114-4200
Country : US
Telephone Number : 215-612-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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