Provider Demographics
NPI:1134152952
Name:FITZSIMMONS, GINA (DO)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5649 WYNNEWOOD DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LAURYS STATION
Practice Address - State:PA
Practice Address - Zip Code:18059-1138
Practice Address - Country:US
Practice Address - Phone:610-261-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041833E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine