MEDICARE: COREY FITZGERALD MSW MPH

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	1041C0700X	Clinical Social Worker	I9374	OH

General Provider Information

NPI Number	:	1417004714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY FITZGERALD MSW MPH

Provider Business Mailing Address
First Line	:	USAMEDDAC WUERZBURG
Second Line	:	ATTN CREDENTIALS UNIT 26610
City	:	APO
State	:	AE
Zip	:	09244
Country	:	DE
Telephone Number	:	011499318043616
Fax Number	:	011499318043241

Provider Business Practice Location Address
First Line	:	USAMEDDAC WUERZBURG
Second Line	:	HOHENFELS
City	:	APO
State	:	AE
Zip	:	09173
Country	:	DE
Telephone Number	:	011499472831710
Fax Number	:	011499472832844

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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