Provider Demographics
NPI:1952357758
Name:FITZPATRICK, DANIEL J (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:341 YOUNGSTOWN KINGSVILLE RD SE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44473-9601
Mailing Address - Country:US
Mailing Address - Phone:330-394-2305
Mailing Address - Fax:330-394-1405
Practice Address - Street 1:341 YOUNGSTOWN KINGSVILLE RD SE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:OH
Practice Address - Zip Code:44473-9601
Practice Address - Country:US
Practice Address - Phone:330-394-2305
Practice Address - Fax:330-394-1405
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0629627Medicaid
OH0629627Medicaid
OH0629627Medicaid