Provider Demographics
NPI:1518973148
Name:FITZHUGH, WALTER DULANY III (MD, MPH)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:DULANY
Last Name:FITZHUGH
Suffix:III
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BLACKSTONE VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1145
Mailing Address - Country:US
Mailing Address - Phone:401-334-1830
Mailing Address - Fax:401-334-1833
Practice Address - Street 1:8 BLACKSTONE VALLEY PL
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1145
Practice Address - Country:US
Practice Address - Phone:401-334-1830
Practice Address - Fax:401-334-1833
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI93132084A0401X
MA787552084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIG43562Medicare UPIN