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Individual
SUSAN ROSE FITZGERALD
Active
Individual
SUSAN ROSE FITZGERALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
MA052827
PA
363A00000X
Physician Assistant
Primary
25MP00174000
NJ
363A00000X
Physician Assistant
MA052828
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25 MP00174000
NJ LICENSE #
NJ
01
—
MA052828
MEDICAL LICENSE
PA
Enumeration date
12/01/2006
Last updated
03/11/2020
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