Provider Demographics
NPI:1831176148
Name:FITZPATRICK, JOHN KEVIN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KEVIN
Last Name:FITZPATRICK
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 1:64 GRANDVIEW ACRES RD
Mailing Address - Street 2:
Mailing Address - City:PHOENICIA
Mailing Address - State:NY
Mailing Address - Zip Code:12464-5301
Mailing Address - Country:US
Mailing Address - Phone:716-601-5419
Mailing Address - Fax:
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:716-601-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT80278207V00000X
MA242431207V00000X
NY206765207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010307607OtherUNIVERA
NY00010307609OtherUNIVERA
NY000525153011OtherBC/BS
NY111517CKOtherPREFERRED CARE
NY040426000844OtherFIDELIS
NY050407000022OtherFIDELIS
NY01775837Medicaid
NY0709873OtherIND. HEALTH
NY0709873OtherIHA
NY000525153009OtherBC/BS
NY452962OtherWELLCARE
NY000525153011OtherBC/BS
NY00010307609OtherUNIVERA
NY111517CKOtherPREFERRED CARE
G74661Medicare UPIN
NY01775837Medicaid