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General NPI Number Information
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NPI Number | 1316114820
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Entity Type | Organization
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Legal Business Name | KATHLEEN FIZGERALD, MD
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 120 DUDLEY ST SUITE 305
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City | PROVIDENCE
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State | RI
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Zip | 02905-2436
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Country | US
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Telephone | 401-453-7555
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Fax | 401-453-7791
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Provider Business Mailing Address
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Address Line | 120 DUDLEY ST SUITE 305
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City | PROVIDENCE
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State | RI
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Zip | 02905-2436
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Country | US
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Telephone | 401-453-7555
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Fax | 401-453-7791
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHLEEN FITZGERALD
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Credential | MD
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Telephone | 401-453-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD5120
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License Number State | RI
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