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NPI Code Detail

MEDICARE: SUSIE FITZGERALD DO

MEDICARE: SUSIE FITZGERALD DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician2021-00367NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2141J6OTHERNCNCBCBS

General Provider Information

NPI Number : 1902867179
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSIE FITZGERALD DO
Provider Business Mailing Address
First Line : PO BOX 260
Second Line :
City : CLINTON
State : NC
Zip : 28329-0260
Country : US
Telephone Number : 910-596-5421
Fax Number : 910-596-5432
Provider Business Practice Location Address
First Line : 607 BEAMAN ST
Second Line :
City : CLINTON
State : NC
Zip : 28328-2603
Country : US
Telephone Number : 910-596-5421
Fax Number : 910-596-5432
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 06/30/2022

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