Provider Demographics
NPI:1487659330
Name:FITZGERALD, DONNA M (PA)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:FELDBERG 7 OUTPATIENT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-6841
Mailing Address - Fax:617-667-7978
Practice Address - Street 1:330 BROOKLINE AVENUE
Practice Address - Street 2:7 FELDBERG OUTPATIENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-6841
Practice Address - Fax:617-667-7978
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA2147363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH222594672OtherGREATWEST HEALTHCARE
NH2139341OtherCIGNA
NH222594672OtherTRICARE
NH30332576Medicaid
NH222594672OtherHEALTHCARE VALUE MANAGE
NHP31177Medicare UPIN
NH222594672OtherHEALTHCARE VALUE MANAGE