Provider Demographics
NPI:1619939907
Name:FITZPATRICK, DEBORAH WATSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:WATSON
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6400 SHAFER CT STE 700
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4989
Mailing Address - Country:US
Mailing Address - Phone:346-376-1702
Mailing Address - Fax:224-532-2780
Practice Address - Street 1:5457 TWIN KNOLLS RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3263
Practice Address - Country:US
Practice Address - Phone:410-689-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00122748OtherR/R MEDICARE#
MDCN6601OtherR/R MEDICARE GROUP #
MD402917800Medicaid
MD402917800Medicaid
MDH96267Medicare UPIN