Provider Demographics
NPI:1144287780
Name:FITZGERALD, ANDREA C (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:C
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:COLLERIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7401 OSLER DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7673
Mailing Address - Country:US
Mailing Address - Phone:410-828-8077
Mailing Address - Fax:410-828-8077
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-828-8077
Practice Address - Fax:410-828-8077
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054728207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD836300500Medicaid
MDH492Medicare ID - Type Unspecified
MDH13689Medicare UPIN