Provider Demographics
NPI:1487602587
Name:FRITZ, BERNARD T (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:T
Last Name:FRITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BARNEY
Other - Middle Name:
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:19 KRISTIN DR
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-5619
Mailing Address - Country:US
Mailing Address - Phone:603-314-4771
Mailing Address - Fax:
Practice Address - Street 1:1 HIGHLANDER WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-314-4771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103444207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00765838OtherRAILROAD MEDICARE
MO207335001Medicaid
MOP00765838OtherRAILROAD MEDICARE
MO936495280Medicare PIN
IL$$$$$$$$$-1Medicaid
MO936494740Medicare PIN
MO936493210Medicare PIN
MOP00765838OtherRAILROAD MEDICARE