Provider Demographics
NPI:1881651107
Name:FITZELL, JOHN T (PA C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:FITZELL
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 411
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2323
Mailing Address - Country:US
Mailing Address - Phone:484-629-2282
Mailing Address - Fax:610-691-7882
Practice Address - Street 1:2597 SCHOENERSVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:610-691-0973
Practice Address - Fax:610-691-7882
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000849L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA000849LOtherSTATE LICENSE
PA879168LPBMedicare PIN