Provider Demographics
NPI:1609223296
Name:FRITCH, GEORGE R IV (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:FRITCH
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 N 7TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-1061
Mailing Address - Country:US
Mailing Address - Phone:812-238-7631
Mailing Address - Fax:812-238-7003
Practice Address - Street 1:1530 N 7TH ST STE 201
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1061
Practice Address - Country:US
Practice Address - Phone:812-238-7631
Practice Address - Fax:812-238-7003
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11018679A207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program