Provider Demographics
NPI:1487628087
Name:FITZGERALD, VIRGINIA (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2245
Mailing Address - Country:US
Mailing Address - Phone:617-269-7500
Mailing Address - Fax:617-464-7512
Practice Address - Street 1:409 W BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2245
Practice Address - Country:US
Practice Address - Phone:617-269-7500
Practice Address - Fax:617-464-7512
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54611208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00000008295OtherBMC HEALTHNET
MA202216BMCOtherHARVARD PILGRIM
MA054611OtherTUFTS HEALTH PLAN
MAB10338103OtherCIGNA
MD202216BMCOtherFIRST SENIORITY
MA0018245OtherNEIGHBORHOOD HEALTH PLAN
MAJ31632OtherBLUE CROSS
MD202216BMCOtherFIRST SENIORITY