Healthcare Provider Details

I. General information

NPI: 1831176148
Provider Name (Legal Business Name): JOHN KEVIN FITZPATRICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/02/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

64 GRANDVIEW ACRES RD
PHOENICIA NY
12464-5301
US

V. Phone/Fax

Practice location:
  • Phone: 716-601-5419
  • Fax:
Mailing address:
  • Phone: 716-601-5419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number80278
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number242431
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number206765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: