Provider Demographics
NPI:1184642357
Name:FITZGERALD, JOHN J III (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:FITZGERALD
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:721 ARBOR WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1974
Mailing Address - Country:US
Mailing Address - Phone:215-540-1516
Mailing Address - Fax:215-540-1597
Practice Address - Street 1:721 ARBOR WAY STE 103
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1974
Practice Address - Country:US
Practice Address - Phone:215-540-1516
Practice Address - Fax:215-540-1597
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005208L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00114386800Medicaid
PA435767Medicare ID - Type Unspecified
PA00114386800Medicaid