Provider Demographics
NPI:1609846724
Name:BIRMINGHAM, FITZGERALD (MD)
Entity type:Individual
Prefix:DR
First Name:FITZGERALD
Middle Name:
Last Name:BIRMINGHAM
Suffix:
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 1:106 IRVING ST NW
Mailing Address - Street 2:#4200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-877-5801
Mailing Address - Fax:202-829-0425
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:4200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-877-5801
Practice Address - Fax:202-829-0425
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD20545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD20545OtherLICENSE NUMBER
DCF99314Medicare UPIN