Provider Demographics
NPI:1730175209
Name:FITZGERALD, SUSAN KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 ASHTON AVE
Mailing Address - Street 2:STE. 207
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5622
Mailing Address - Country:US
Mailing Address - Phone:703-334-5801
Mailing Address - Fax:703-334-5805
Practice Address - Street 1:8100 ASHTON AVE
Practice Address - Street 2:STE. 207
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5622
Practice Address - Country:US
Practice Address - Phone:703-334-5801
Practice Address - Fax:703-334-5805
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2011-01-06
Deactivation Date:2005-09-21
Deactivation Code:
Reactivation Date:2005-09-26
Provider Licenses
StateLicense IDTaxonomies
VA0101057533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2199062OtherAETNA HMO
VA309288OtherANTHEM BC/BS
VA5649863OtherCIGNA PPO/HMO
7049008OtherAETNA
VA5649863OtherCIGNA PPO/HMO