Provider Demographics
NPI:1821885674
Name:FITZGERALD, JAMES IRA IV
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:IRA
Last Name:FITZGERALD
Suffix:IV
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 COLERAIN AVE UNIT 14
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6474
Mailing Address - Country:US
Mailing Address - Phone:513-928-0788
Mailing Address - Fax:
Practice Address - Street 1:4769 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-6107
Practice Address - Country:US
Practice Address - Phone:513-928-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator