Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 12842 | MA |
NPI | 1851378442 |
---|---|
Provider Name | Dr. Paul F Fitzgerald |
First Address | South Yarmouth, MA 02664-1863 |
Second Address | South Yarmouth, MA 02664-1863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T57154 | (02) | MA |