Healthcare Provider Details

I. General information

NPI: 1801917216
Provider Name (Legal Business Name): PATRICK FITZPATRICK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 ST. JONSBURY RD.
LITTLETON NH
03561
US

IV. Provider business mailing address

PO BOX 160 PATIENT FINANCIAL SERVICES
LITTLETON NH
03561
US

V. Phone/Fax

Practice location:
  • Phone: 603-444-2450
  • Fax:
Mailing address:
  • Phone: 603-259-7627
  • Fax: 603-259-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number14868
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number14868
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: