Basic Information
| Provider Information | |||||||||
| NPI: | 1215928296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITZGERALD | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 BUTTRICK RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | LONDONDERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030533417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035371300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 160 S RIVER RD | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035371300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11271 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 579481 | 01 | NH | CIGNA PIN | OTHER | 01YP03156NH02 | 01 | NH | ANTHEM ACES PIN | OTHER | 30201509 | 05 | NH | MEDICAID | 2591895 | 01 | NH | AETNA PIN | OTHER | 0140906 | 01 | NH | UHC PIN | OTHER | 101115803 | 01 | NH | W/C DEPT OF LABOR PIN | OTHER | H02395 | 01 | NH | ANTHEM REFERRING UPIN | OTHER | 011271 | 01 | NH | TUFTS PIN | OTHER | 080176810 | 01 | RR MEDICARE PIN | OTHER | NH2108 | 01 | NH | HPHC PIN | OTHER |