Individual provider Active NPI

Kyle Tyrone Fitzgerald, DO

  • Student in an Organized Health Care Education/Training Program
  • Philadelphia, PA
National Provider Identifier
1861332108
Registry record updated Mar 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
10800 Knights Rd
Philadelphia, PA 19114-4200
Phone
(215) 612-4000
NPI assigned
Mar 30, 2026
Last updated
Mar 30, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PA Primary

Addresses

Primary practice location

10800 Knights Rd
Philadelphia, PA 19114-4200

Mailing address

10800 Knights Rd
Attn: Graduate Medical Education Family Medicine
Philadelphia, PA 19114-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1774828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774828800000",
    "number": "1861332108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 KNIGHTS RD",
            "address_2": "ATTN: GRADUATE MEDICAL EDUCATION FAMILY MEDICINE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191144200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 KNIGHTS RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191144200",
            "telephone_number": "215-612-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "KYLE",
        "middle_name": "TYRONE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-03-30",
        "last_updated": "2026-03-30",
        "certification_date": "2026-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.