Provider Demographics
NPI:1588813513
Name:FITZPATRICK, TAMA CATELL (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:TAMA
Middle Name:CATELL
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-7334
Mailing Address - Fax:207-973-7424
Practice Address - Street 1:905 UNION ST STE 11
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3039
Practice Address - Country:US
Practice Address - Phone:207-973-7334
Practice Address - Fax:207-973-7424
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI800133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered