MEDICARE: SUSAN M FITZGERALD LIC. AC.

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	171100000X	Acupuncturist	221051	MA

General Provider Information

NPI Number	:	1376734939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M FITZGERALD LIC. AC.

Provider Business Mailing Address
First Line	:	46 MAYFLOWER CIR
Second Line	:
City	:	WHITMAN
State	:	MA
Zip	:	02382-1142
Country	:	US
Telephone Number	:	781-925-0379
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 NANTASKET AVE
Second Line	:	BODYWORK DAY SPA
City	:	HULL
State	:	MA
Zip	:	02045-2521
Country	:	US
Telephone Number	:	781-925-0379
Fax Number	:

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

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/07/2007

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