Provider Demographics
NPI:1437285129
Name:FITZPATRICK, ROBERT JOHN (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 FARMINGTON AVENUE MC 6210
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-6210
Mailing Address - Country:US
Mailing Address - Phone:860-679-2893
Mailing Address - Fax:860-679-1349
Practice Address - Street 1:270 FARMINGTON AVENUE MC 6210
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-6210
Practice Address - Country:US
Practice Address - Phone:860-679-2893
Practice Address - Fax:860-679-1349
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000227207R00000X, 2083X0100X
MA70492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1437285129Medicaid