Provider Demographics
NPI:1447269899
Name:LEHAN-FITZGERALD, ELAINE N (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:N
Last Name:LEHAN-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:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-0156
Mailing Address - Country:US
Mailing Address - Phone:413-747-0705
Mailing Address - Fax:413-747-0705
Practice Address - Street 1:305 MAPLE ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2765
Practice Address - Country:US
Practice Address - Phone:413-525-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2231612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300865Medicaid
MA1300865Medicaid
MAA37862Medicare ID - Type Unspecified