Provider Demographics
NPI:1043389745
Name:FITZGERALD, TOBY M (DO)
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TOBY
Other - Middle Name:M
Other - Last Name:GARD-WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:887 CONGRESS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3166
Mailing Address - Country:US
Mailing Address - Phone:207-771-5549
Mailing Address - Fax:207-771-7834
Practice Address - Street 1:887 CONGRESS ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3166
Practice Address - Country:US
Practice Address - Phone:207-771-5549
Practice Address - Fax:207-771-7834
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME02153207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1043389745Medicaid
AA182841OtherHARVARD
9979562OtherAETNA
2103148OtherCIGNA
ME001748001Medicare PIN