Basic Information
| Provider Information | |||||||||
| NPI: | 1154522266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITZPATRICK | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | MCCAMANT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 783311 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191783311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844500 | ||||||||
| FaxNumber: | 4848840699 | ||||||||
| Practice Location | |||||||||
| Address1: | 5649 WYNNEWOOD DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | LAURYS STATION | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180591138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102626641 | ||||||||
| FaxNumber: | 6102620428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 02/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD431533 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | FF0258738 | 01 | PA | DEA | OTHER | MD431533 | 01 | PA | MEDICAL LICENSE | OTHER |