Healthcare Provider Details

I. General information

NPI: 1720906845
Provider Name (Legal Business Name): EDWARD FITZGERALD RD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7304 MASSACHUSETTS CT
RALEIGH NC
27615-5639
US

IV. Provider business mailing address

7304 MASSACHUSETTS CT
RALEIGH NC
27615-5639
US

V. Phone/Fax

Practice location:
  • Phone: 919-279-0889
  • Fax:
Mailing address:
  • Phone: 919-279-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: EDWARD FITZGERALD
Title or Position: REGISTERED DIETITIAN
Credential: RD, LDN
Phone: 919-279-0889