Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TA1634 | MD |
NPI | 1013139815 |
---|---|
Provider Name | Julie Fitzgerald |
First Address | Glen Burnie, MD 21061-4966 |
Second Address | Glen Burnie, MD 21061-4966 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 23/03/2016 |