Individual
THOMAS J FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF RADIATION ONCOLOGY, WORCESTER, MA 01655-0002
(508) 856-5551
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
52720
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110065283A
—
MA
01
—
4485196
AETNA
MA
01
—
920001819
RR MEDICARE PRIMARY SITE
MA
01
—
J0395302
MEDICARE SECONDARY SITE
MA
01
—
P00762759
RR MEDICARE - SECONDARY SITE
MA
Enumeration date
11/30/2005
Last updated
11/10/2020
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