Provider Demographics
NPI:1134357346
Name:FITZGERALD, KATHERINE E (DO)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MAIN ST
Mailing Address - Street 2:HEYWOOD FAMILY MEDICINE
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2927
Mailing Address - Country:US
Mailing Address - Phone:978-630-5030
Mailing Address - Fax:978-630-5033
Practice Address - Street 1:266 MAIN ST
Practice Address - Street 2:HEYWOOD FAMILY MEDICINE
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2927
Practice Address - Country:US
Practice Address - Phone:978-630-5030
Practice Address - Fax:978-630-5033
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110094256AMedicaid
MAM21141OtherMEDICARE GROUP# - FAMILY MEDICAL & MATERNITY CARE, PC
MA002895201Medicare PIN