MEDICARE: MS. DONNA M. FITZGERALD P.A.

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	363AM0700X	Medical Physician Assistant	2147	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	222594672	OTHER	NH	GREATWEST HEALTHCARE
2	2139341	OTHER	NH	CIGNA
3	222594672	OTHER	NH	TRICARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	222594672	OTHER	NH	HEALTHCARE VALUE MANAGE

General Provider Information

NPI Number	:	1487659330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA M. FITZGERALD P.A.

Provider Business Mailing Address
First Line	:	330 BROOKLINE AVE
Second Line	:	FELDBERG 7 OUTPATIENT
City	:	BOSTON
State	:	MA
Zip	:	02215-5400
Country	:	US
Telephone Number	:	617-667-6841
Fax Number	:	617-667-7978

Provider Business Practice Location Address
First Line	:	330 BROOKLINE AVENUE
Second Line	:	7 FELDBERG OUTPATIENT
City	:	BOSTON
State	:	MA
Zip	:	02215-5400
Country	:	US
Telephone Number	:	617-667-6841
Fax Number	:	617-667-7978

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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