Provider Demographics
NPI:1932129988
Name:FITZGERALD, JOHN EDMUND (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDMUND
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8001 FRANKLIN FARMS DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5108
Mailing Address - Country:US
Mailing Address - Phone:804-521-5800
Mailing Address - Fax:804-545-4340
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 505
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-282-2685
Practice Address - Fax:804-282-0780
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101022536207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1463161OtherCIGNA
VI311989OtherMAMSI
VA27413300OtherFEDERAL BLUCK LUNG
VA276269OtherANTHEM/VA HEALTHKEEPERS
VA276294OtherANTHEM/VA HEALTHKEEPERS
VA11869VOtherANTHEM/VA HEALTHKEEPERS
VA103793OtherANTHEM/VA HEALTHKEEPERS
VA56192OtherSOUTHERN HEALTH SERVICES
VA25-00009OtherUNITED HEALTHCARE
VA276196OtherANTHEM/VA HEALTHKEEPERS
VA60015038OtherRAILROAD MEDICARE
VA6060919Medicaid
VA276351OtherANTHEM/VA HEALTHKEEPERS
VA4137155OtherAETNA/US HEALTHCARE
VA276227OtherANTHEM/VA HEALTHKEEPERS
VA44220OtherSENTARA HEALTH/OPTIMA
VA730049OtherAETNA/US HEALTHCARE HMO
VA276269OtherANTHEM/VA HEALTHKEEPERS
VAB05044Medicare UPIN