Provider Demographics
NPI:1760475859
Name:FITZPATRICK, JAMES WILLIS (D O)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIS
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:SUITE 280
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5736
Practice Address - Country:US
Practice Address - Phone:843-789-1786
Practice Address - Fax:843-958-1263
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005031L207R00000X
SC1546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009322000001Medicaid
PA110042361OtherRAILROAD MEDICARE
PA0009322000001Medicaid
PAC29938Medicare UPIN