Provider Demographics
NPI:1366479289
Name:FITZGERALD, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:322 PARK AVE
Practice Address - Street 2:LAKESHORE ORTHOPEDIC GROUP PC
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2237
Practice Address - Country:US
Practice Address - Phone:716-366-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1544051207X00000X
NY154405-01207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01006711Medicaid
NY34634EMedicare PIN
D74884Medicare UPIN
NY01006711Medicaid
NY53007DMedicare PIN