Provider Demographics
NPI:1942364328
Name:FITZGERALD, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:903 NORTHEAST DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7416
Mailing Address - Country:US
Mailing Address - Phone:704-894-9309
Mailing Address - Fax:704-894-9304
Practice Address - Street 1:903 NORTHEAST DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036
Practice Address - Country:US
Practice Address - Phone:704-894-9309
Practice Address - Fax:704-894-9304
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93-001122084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562277677OtherBCBS OF NC
NC8932269Medicaid
NCB3348OtherMEDCOST
NC562277677OtherCIGNA
NC562277677OtherBCBS OF NC
NC8932269Medicaid