Healthcare Provider Details

I. General information

NPI: 1871416347
Provider Name (Legal Business Name): TIMOTHY FITZPATRICK RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 BUCK RUB LN
MIDLOTHIAN VA
23112-6110
US

IV. Provider business mailing address

7300 BUCK RUB LN
MIDLOTHIAN VA
23112-6110
US

V. Phone/Fax

Practice location:
  • Phone: 757-472-2852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: