Provider Demographics
NPI:1013139815
Name:FITZGERALD, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 LANDMARK DR
Mailing Address - Street 2:STE 114
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4966
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:806 LANDMARK DR
Practice Address - Street 2:STE 114
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4966
Practice Address - Country:US
Practice Address - Phone:410-590-9260
Practice Address - Fax:410-590-9266
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1634152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist