Active NPI
Michael A Fitzgerald, MD
- Gastroenterology Physician
- Syracuse, NY
National Provider Identifier
1083634109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 1189823
- Practice address
- 4870 Broad Rd
Suite 3Q
Syracuse, NY 13215-2206 - Phone
- (315) 492-5292
- Fax
- (315) 492-5123
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 1189823 | NY | Primary |
Addresses
Primary practice location
4870 Broad Rd
Suite 3Q
Syracuse, NY 13215-2206
Mailing address
4870 Broad Rd
Suite 3Q
Syracuse, NY 13215-2206
Phone (315) 492-5292
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00482260 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1189823 | NY | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204761600000",
"number": "1083634109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4870 BROAD RD",
"address_2": "SUITE 3Q",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132152206",
"telephone_number": "315-492-5292",
"fax_number": "315-492-5123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4870 BROAD RD",
"address_2": "SUITE 3Q",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132152206",
"telephone_number": "315-492-5292",
"fax_number": "315-492-5123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FITZGERALD",
"first_name": "MICHAEL",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2008-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "NY",
"license": "1189823",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00482260",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.