Provider Demographics
NPI:1437582632
Name:FITZGERALD, CARILYNN SUE (HEARING SPECIALIST)
Entity Type:Individual
Prefix:
First Name:CARILYNN
Middle Name:SUE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:HEARING SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VILLAGE DR
Mailing Address - Street 2:SAM'S CLUB #4952
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084
Mailing Address - Country:US
Mailing Address - Phone:724-715-1430
Mailing Address - Fax:
Practice Address - Street 1:2000 VILLAGE DR
Practice Address - Street 2:SAM'S CLUB #4952
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084
Practice Address - Country:US
Practice Address - Phone:724-715-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF00315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist