Provider Demographics
NPI:1144222415
Name:FITZPATRICK, EDWARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
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 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-826-4460
Mailing Address - Fax:860-224-6260
Practice Address - Street 1:1 LAKE ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1396
Practice Address - Country:US
Practice Address - Phone:860-826-4460
Practice Address - Fax:860-826-4436
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035599207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT035599-1831OtherCONNECTICARE MERIDEN
CT1255448155OtherGHMC GRP NPI ID
CT004214433OtherGHMC GRP CAID ID
CT060173OtherHEALTH NET PROV ID
CTCT5599OtherEYE MED VISION CARE
CT035599-3714OtherCONNECTICARE NB LOCATION
CT136392OtherWELLCARE MEDICARE
CT010035599CT01OtherBCBS NB LOCATION
CT010035599CT03OtherBCBS MERIDEN LOCATION
CT914443OtherBLOCK VISION ID
CTC01373OtherGHMC GRP MEDICARE ID
CTP422705OtherOXFORD ID
CT932774OtherHEALTH NET REF ID
CT01035599OtherCIGNA PROV ID
CT5907379OtherAETNA REF ID
CT001355991Medicaid
CT035599-1831OtherCONNECTICARE MERIDEN
F66422Medicare UPIN