Provider Demographics
NPI:1679773014
Name:E. L. FITCH MD, FAMILY MEDICINE INC.
Entity Type:Organization
Organization Name:E. L. FITCH MD, FAMILY MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-979-1224
Mailing Address - Street 1:4859 DOVER CENTER RD
Mailing Address - Street 2:SUITE #10
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3184
Mailing Address - Country:US
Mailing Address - Phone:440-979-1224
Mailing Address - Fax:440-979-9730
Practice Address - Street 1:4859 DOVER CENTER RD
Practice Address - Street 2:SUITE #10
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3184
Practice Address - Country:US
Practice Address - Phone:440-979-1224
Practice Address - Fax:440-979-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34049701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty