Provider Demographics
NPI:1275745655
Name:FITZHENRY, LAURENCE N IV (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:N
Last Name:FITZHENRY
Suffix:IV
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 1:352 S DELSEA DR STE C
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5306
Mailing Address - Country:US
Mailing Address - Phone:856-690-1616
Mailing Address - Fax:856-690-1089
Practice Address - Street 1:352 S DELSEA DR STE C
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5306
Practice Address - Country:US
Practice Address - Phone:856-690-1616
Practice Address - Fax:856-690-1089
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437420207L00000X, 207LP2900X
NJ25MA09824900207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102319486Medicaid
PA102319486Medicaid
NJ475002Medicare PIN