Provider Demographics
NPI:1790791390
Name:FITZGERALD, KATHLEEN M (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
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:EAST MILTON PEDIATRIC ASSOC
Mailing Address - Street 2:464 GRANITE AVENUE
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5625
Mailing Address - Country:US
Mailing Address - Phone:617-696-5900
Mailing Address - Fax:
Practice Address - Street 1:EAST MILTON PEDIATRIC ASSOC
Practice Address - Street 2:464 GRANITE AVENUE
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5625
Practice Address - Country:US
Practice Address - Phone:617-696-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71622208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics