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General NPI Number Information
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NPI Number | 1811907819
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Entity Type | Individual
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Provider Name | TIMOTHY SHAWN FITZGERALD PA
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 1717 SHIPYARD BLVD SUITE 350
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City | WILMINGTON
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State | NC
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Zip | 28403-8023
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Country | US
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Telephone | 910-799-0110
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Fax | 910-799-1958
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Provider Business Mailing Address
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Address Line | 1202 MEDICAL CENTER DR STE 350
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City | WILMINGTON
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State | NC
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Zip | 28401-7307
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Country | US
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Telephone | 910-617-6705
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Fax | 910-431-4048
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 112679
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 112679
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 112679
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License Number State | NC
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