Provider Demographics
NPI:1689945164
Name:FITZGERALD, ELLEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:B
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PINCKARD PIKE
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-9658
Mailing Address - Country:US
Mailing Address - Phone:859-321-6301
Mailing Address - Fax:
Practice Address - Street 1:150 PINCKARD PIKE
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-9658
Practice Address - Country:US
Practice Address - Phone:859-321-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36178207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology