Provider Demographics
NPI:1063459246
Name:FITZPATRICK, JAMES E (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 MACK RD STE 310
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5376
Mailing Address - Country:US
Mailing Address - Phone:513-924-8895
Mailing Address - Fax:513-924-8909
Practice Address - Street 1:3050 MACK RD STE 310
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5376
Practice Address - Country:US
Practice Address - Phone:513-924-8895
Practice Address - Fax:513-924-8909
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077754F208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64099229Medicaid
OH2191579Medicaid
KY64099229Medicaid
OHH15239Medicare PIN
000000077510OtherANTHEM
7775402OtherCHOICE CARE
311474851030OtherCARESOURCE
OHFI4019081Medicare ID - Type Unspecified
1701549OtherUNITED HEALTHCARE
2345843OtherAETNA
7775402OtherHUMANA
H15239Medicare UPIN
KY64099229Medicaid