Provider Demographics
NPI:1447217823
Name:FITZGERALD, MARIE HOLMAN (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:HOLMAN
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 1:3051 CHURCHILL DR STE 130
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2710
Mailing Address - Country:US
Mailing Address - Phone:972-539-0086
Mailing Address - Fax:972-355-9680
Practice Address - Street 1:3051 CHURCHILL DR STE 130
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2710
Practice Address - Country:US
Practice Address - Phone:972-539-0086
Practice Address - Fax:972-355-9680
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8136207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH8136OtherLICENSE
TX88G099Medicare ID - Type Unspecified