Provider Demographics
NPI:1780855890
Name:FITZPATRICK, PAMELA MARIA
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARIA
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4513
Mailing Address - Country:US
Mailing Address - Phone:203-438-2333
Mailing Address - Fax:
Practice Address - Street 1:407 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4513
Practice Address - Country:US
Practice Address - Phone:203-438-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist