Provider Demographics
NPI:1033170469
Name:FITZGERALD, MARCIE L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:L
Last Name:FITZGERALD
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 8500 LOCKBOX #7642
Mailing Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8478
Mailing Address - Fax:813-281-8113
Practice Address - Street 1:1645 WEST 8TH STREET
Practice Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN ERIE
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-5097
Practice Address - Country:US
Practice Address - Phone:814-875-8728
Practice Address - Fax:814-875-8796
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-10-01
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Provider Licenses
StateLicense IDTaxonomies
PAMA002756L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant