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NPI Code Detail

MEDICARE: NIALL J FITZGERALD

MEDICARE: NIALL J FITZGERALD
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1457991879
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIALL J FITZGERALD
Provider Business Mailing Address
First Line : PO BOX 8459
Second Line :
City : PORTLAND
State : OR
Zip : 97207-8459
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2270 SE CESAR E CHAVEZ BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97214-5916
Country : US
Telephone Number : 503-963-8337
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2020
Last Update Date : 01/14/2020

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Directions to “ NIALL J FITZGERALD ” Practice Location

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