Provider Demographics
NPI:1043233695
Name:FITZPATRICK, MICHAEL STEPHEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 EASTERN AVE
Mailing Address - Street 2:STE 135
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1100
Mailing Address - Country:US
Mailing Address - Phone:717-597-3151
Mailing Address - Fax:717-597-8933
Practice Address - Street 1:50 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1100
Practice Address - Country:US
Practice Address - Phone:717-597-3151
Practice Address - Fax:717-597-8933
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201887207Q00000X
TN1695207Q00000X
PAOS012535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I46204Medicare UPIN