Provider Demographics
NPI:1821124959
Name:FITZPATRICK, HENDRIEKA A (MD)
Entity Type:Individual
Prefix:
First Name:HENDRIEKA
Middle Name:A
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HENDRIEKA
Other - Middle Name:ANN
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:111 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4169
Mailing Address - Country:US
Mailing Address - Phone:833-824-6633
Mailing Address - Fax:
Practice Address - Street 1:111 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4169
Practice Address - Country:US
Practice Address - Phone:833-824-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME-47047Medicare UPIN