| Fitzgerald Primary Care Llc | |
|
2232 E Monument St Baltimore MD 21205-2431 | |
| (667) 207-3552 | |
| Not Available |
| Full Name | Fitzgerald Primary Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2232 E Monument St, Baltimore, Maryland |
| Authorized Official Name and Position | Tarnisha Fitzgerald (SOLE PROPRIETOR) |
| Authorized Official Contact | 4437637154 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fitzgerald Primary Care Llc 2232 E Monument St Baltimore MD 21205-2431 Ph: (667) 207-3552 | Fitzgerald Primary Care Llc 2232 E Monument St Baltimore MD 21205-2431 Ph: (667) 207-3552 |
| NPI Number | 1902382252 |
|---|---|
| Provider Enumeration Date | 07/18/2018 |
| Last Update Date | 05/16/2024 |
| Medicare PECOS PAC ID | 7214285592 |
|---|---|
| Medicare Enrollment ID | O20180802001242 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902382252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (Maryland) | Primary |
| Provider Name | Tarnisha L Fitzgerald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164940656 PECOS PAC ID: 7214284645 Enrollment ID: I20180717001722 |
| Provider Name | Walter Lewis Toller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760060636 PECOS PAC ID: 9537572839 Enrollment ID: I20210810000116 |
| Provider Name | Kaddie Kallon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427519404 PECOS PAC ID: 6608204037 Enrollment ID: I20220907003491 |
| Provider Name | Nicole S Queen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073238846 PECOS PAC ID: 0345694485 Enrollment ID: I20230925000139 |
| Provider Name | Jennifer Laidley-kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518742949 PECOS PAC ID: 4789901034 Enrollment ID: I20231120000098 |
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