Healthcare Provider Details

I. General information

NPI: 1437200060
Provider Name (Legal Business Name): COLLEEN MARIE FITZPATRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SISTER PIERRE DRIVE SUITE 304
TOWSON MD
21204-7526
US

IV. Provider business mailing address

120 SISTER PIERRE DRIVE SUITE 304
TOWSON MD
21204-7526
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-2877
  • Fax: 410-337-2839
Mailing address:
  • Phone: 410-337-2877
  • Fax: 410-337-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0029169
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: