Provider Demographics
NPI:1245251495
Name:NEWSOM & FITZPATRICK MEDICAL GROUP INC
Entity type:Organization
Organization Name:NEWSOM & FITZPATRICK MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-271-2225
Mailing Address - Street 1:150 CATHERINE LN
Mailing Address - Street 2:SUITE G
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5719
Mailing Address - Country:US
Mailing Address - Phone:530-271-2225
Mailing Address - Fax:530-271-7245
Practice Address - Street 1:150 CATHERINE LN
Practice Address - Street 2:SUITE G
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5719
Practice Address - Country:US
Practice Address - Phone:530-271-2225
Practice Address - Fax:530-271-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A635230207Q00000X
CA00G25383207Q00000X, 207R00000X
CA0PA146110363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03594ZMedicare ID - Type Unspecified