Healthcare Provider Details

I. General information

NPI: 1730169798
Provider Name (Legal Business Name): DENNIS C FITZGERALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 LINTON BLVD STE E2
DELRAY BEACH FL
33484-6595
US

IV. Provider business mailing address

925 CHESTNUT ST FL 6
PHILADELPHIA PA
19107-4204
US

V. Phone/Fax

Practice location:
  • Phone: 615-391-3333
  • Fax: 561-495-7992
Mailing address:
  • Phone: 215-955-6760
  • Fax: 215-923-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD13305
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME164572
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: