Provider Demographics
NPI:1114917879
Name:FITZGERALD, THOMAS E (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CONGRESS ST
Mailing Address - Street 2:STE 304
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0909
Mailing Address - Country:US
Mailing Address - Phone:617-479-7333
Mailing Address - Fax:617-773-0198
Practice Address - Street 1:700 CONGRESS ST
Practice Address - Street 2:STE 304
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0909
Practice Address - Country:US
Practice Address - Phone:617-479-7333
Practice Address - Fax:617-773-0198
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA51025208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8164OtherHPHC
MA051025OtherTUFTS
MA6175732Medicaid
MA051025OtherTUFTS
MA6175732Medicaid