Provider Demographics
NPI:1245365923
Name:FITZPATRICK MORAN COSTA & HAAG-RICKERT LLP
Entity type:Organization
Organization Name:FITZPATRICK MORAN COSTA & HAAG-RICKERT LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-781-6210
Mailing Address - Street 1:299 CAREW ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2301
Mailing Address - Country:US
Mailing Address - Phone:413-781-6210
Mailing Address - Fax:413-733-7570
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2301
Practice Address - Country:US
Practice Address - Phone:413-781-6210
Practice Address - Fax:413-733-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093864/AMedicaid
MA0028819Medicare PIN
MAE01926Medicare UPIN
MAG11598Medicare UPIN
MAA20385Medicare ID - Type Unspecified
MA3195449Medicaid
MAG69738Medicare UPIN
MA3045510Medicaid
MAE51787Medicare UPIN
MA3181430Medicare ID - Type Unspecified
MAJ08208Medicare ID - Type Unspecified
MAJ09912Medicare ID - Type Unspecified