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General NPI Number Information
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NPI Number | 1083999098
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Entity Type | Organization
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Legal Business Name | DANIEL J. FITZPATRICK, D.O.
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 341 YOUNGSTOWN KINGSVILLE RD SE
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City | VIENNA
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State | OH
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Zip | 44473-9601
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Country | US
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Telephone | 330-394-2305
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Fax | 330-394-1405
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Provider Business Mailing Address
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Address Line | 2219 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44483-6105
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Country | US
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Telephone | 330-394-2305
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Fax | 330-394-1405
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANIEL FITZPATRICK
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Credential | D.O.
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Telephone | 330-394-1405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | 30-00-3237
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License Number State | OH
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