Provider Demographics
NPI:1710175658
Name:FITZGIBBONS, RICHARD P (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:FITZGIBBONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 FOUR FALLS CENTER
Mailing Address - Street 2:SUITE 312
Mailing Address - City:W. CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2950
Mailing Address - Country:US
Mailing Address - Phone:610-397-0950
Mailing Address - Fax:610-397-0954
Practice Address - Street 1:1001 CONSHOHOCKEN STATE RD
Practice Address - Street 2:SUITE 312
Practice Address - City:WEST CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2970
Practice Address - Country:US
Practice Address - Phone:610-397-0950
Practice Address - Fax:610-397-0954
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA011908E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry