Provider Demographics
NPI:1154456911
Name:FITZGERALD, EDWARD BRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRICE
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8857
Mailing Address - Country:US
Mailing Address - Phone:317-844-8190
Mailing Address - Fax:317-569-0123
Practice Address - Street 1:1616 W 116TH ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8857
Practice Address - Country:US
Practice Address - Phone:317-844-8190
Practice Address - Fax:317-569-0123
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022613A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01022163AOtherSTATE LICENSE