Provider Demographics
NPI:1265437560
Name:FITZPATRICK, CHARLES H (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1238
Mailing Address - Country:US
Mailing Address - Phone:856-482-2933
Mailing Address - Fax:856-482-2936
Practice Address - Street 1:2432 ROUTE 38
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1238
Practice Address - Country:US
Practice Address - Phone:856-482-2933
Practice Address - Fax:856-482-2936
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA000419000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0062208000OtherAMERIHEALTH
1110718OtherCIGNA
079056OtherPA BLUE SHIEL
34954OtherAETNA
P2042310OtherOXFORD HEALTH PLANS
1K5332OtherHEALTHNET OF NJ
81092OtherCOVENTRY HEALTHCARE
1821425OtherUNITED HEALTHCARE
CF0C527510OtherWELLCHOICE
079056OtherPA BLUE SHIEL
1K5332OtherHEALTHNET OF NJ
1821425OtherUNITED HEALTHCARE