MEDICARE: MRS. MARCIE L FITZGERALD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA002756L	PA

General Provider Information

NPI Number	:	1033170469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCIE L FITZGERALD PA-C

Provider Business Mailing Address
First Line	:	PO BOX 8500 LOCKBOX #7642
Second Line	:	SHRINERS HOSPITALS FOR CHILDREN
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-7642
Country	:	US
Telephone Number	:	813-281-8478
Fax Number	:	813-281-8113

Provider Business Practice Location Address
First Line	:	1645 WEST 8TH STREET
Second Line	:	SHRINERS HOSPITALS FOR CHILDREN ERIE
City	:	ERIE
State	:	PA
Zip	:	16505-5097
Country	:	US
Telephone Number	:	814-875-8728
Fax Number	:	814-875-8796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	10/01/2012

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