Provider Demographics
NPI:1336360742
Name:FRITZ, DOUGLAS STEWART (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:STEWART
Last Name:FRITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAHEY CLINIC
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-213-4040
Mailing Address - Fax:
Practice Address - Street 1:6 KIMBALL LN STE 120
Practice Address - Street 2:LAHEY LYNNFIELD
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2667
Practice Address - Country:US
Practice Address - Phone:781-213-4040
Practice Address - Fax:781-213-5064
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110091141AMedicaid
MA110091141AMedicaid