Healthcare Provider Details

I. General information

NPI: 1447394770
Provider Name (Legal Business Name): LUCRETIA FITZPATRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SARASOTA PATH
GARNET VALLEY PA
19060
US

IV. Provider business mailing address

3 MARYLAND FARMS STE 200
BRENTWOOD TN
37027-5005
US

V. Phone/Fax

Practice location:
  • Phone: 615-345-5400
  • Fax:
Mailing address:
  • Phone: 615-345-5400
  • Fax: 615-345-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD039709E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA05558100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: