Healthcare Provider Details

I. General information

NPI: 1487509667
Provider Name (Legal Business Name): DENNIS MICHAEL FITZGERALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N MAIN ST
PAULDING OH
45879-1241
US

IV. Provider business mailing address

301 N MAIN ST
PAULDING OH
45879-1241
US

V. Phone/Fax

Practice location:
  • Phone: 412-378-4997
  • Fax:
Mailing address:
  • Phone: 412-378-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number5563143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: