Healthcare Provider Details

I. General information

NPI: 1043233695
Provider Name (Legal Business Name): MICHAEL STEPHEN FITZPATRICK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 EASTERN AVE
GREENCASTLE PA
17225-1100
US

IV. Provider business mailing address

50 EASTERN AVE STE 135
GREENCASTLE PA
17225-1100
US

V. Phone/Fax

Practice location:
  • Phone: 717-597-3151
  • Fax: 717-597-8933
Mailing address:
  • Phone: 717-597-3151
  • Fax: 717-597-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102201887
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1695
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS012535
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: