Basic Information
Provider Information | |||||||||
NPI: | 1588813513 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FITZPATRICK | ||||||||
FirstName: | TAMA | ||||||||
MiddleName: | CATELL | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RD,LD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 43 WHITING HILL RD STE 300 | ||||||||
Address2: |   | ||||||||
City: | BREWER | ||||||||
State: | ME | ||||||||
PostalCode: | 044121006 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2079737334 | ||||||||
FaxNumber: | 2079737424 | ||||||||
Practice Location | |||||||||
Address1: | 905 UNION ST STE 11 | ||||||||
Address2: |   | ||||||||
City: | BANGOR | ||||||||
State: | ME | ||||||||
PostalCode: | 044013039 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2079737334 | ||||||||
FaxNumber: | 2079737424 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/15/2008 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI800 | ME | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
No ID Information.