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Individual
TIMOTHY SHAWN FITZGERALD
Active
Individual
TIMOTHY SHAWN FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
112679
NC
363AM0700X
Medical Physician Assistant
112679
NC
363AS0400X
Surgical Physician Assistant
112679
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0197953
CIGNA
NC
01
—
047501023
TRICARE
NC
01
—
0928879
UNITED HEALTHCARE
NC
01
—
30772
BCBS OF NC
NC
01
—
561926376
WORKMANS COMP
NC
05
—
8930772
—
NC
01
—
P00023289
RAILROAD MEDICARE
NC
Enumeration date
08/09/2006
Last updated
01/24/2023
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