Provider Demographics
NPI:1831269299
Name:FITZPATRICK, SEAN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:WILLIAM
Last Name:FITZPATRICK
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 1:38 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2943
Mailing Address - Country:US
Mailing Address - Phone:603-882-2921
Mailing Address - Fax:603-882-8676
Practice Address - Street 1:38 TYLER ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2943
Practice Address - Country:US
Practice Address - Phone:603-882-2921
Practice Address - Fax:603-882-8676
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9094207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80003022Medicaid
F19733Medicare UPIN
NH80003022Medicaid