Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | D31064 | MD |
N | 207R00000X | Internist | D31064 | MD |
N | 111NI0900X | Internist | D31064 | MD |
Y | 207RA0401X | Internist - Addiction Medicine | D31064 | MD |
NPI | 1881683522 |
---|---|
Provider Name | Terrence Thomas Fitzgerald |
First Address | Baltimore, MD 21209-0445 |
Second Address | Baltimore, MD 21212-4230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2005 |
Last Update Date | 21/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0497570 | (05) | DC |
465611300 | (05) | MD |
D76190 | (02) |