Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MA052827 | PA |
NPI | 1346318862 |
---|---|
Provider Name | Susan Rose Fitzgerald |
First Address | Camden, NJ 08103-1088 |
Second Address | Cherry Hill, NJ 08003-2117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25 MP00174000 | NJ LICENSE # (01) | NJ |
MA052828 | MEDICAL LICENSE (01) | PA |
Q78195 | (02) |