Provider Demographics
NPI:1629140587
Name:FITZGERALD, BARRY J (DPM)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 MCKINLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1338
Mailing Address - Country:US
Mailing Address - Phone:716-822-0118
Mailing Address - Fax:
Practice Address - Street 1:843 MCKINLEY PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1338
Practice Address - Country:US
Practice Address - Phone:716-822-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004522213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU13407Medicare UPIN
NY256311Medicare ID - Type Unspecified